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Helmet ~ Infraction Stop Report Form - Goes to Sam Hochberg, A.I. M. Attorney

For use if you live in Oregon - Washington - Idaho - Alaska - Hawaii - California

Personal Data

Your E-Mail Address: Your Name:

Day Time Telephone: Evening Telephone:

Address, City, State & Zip:

May we use your name for legislative purposes? Yes-Use My Name No - DO NOT use my name ~ Please Select ~

What Happened When You Were Stopped?

When were you stopped? January February March April May June July August September October November December ~Select Month~ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ~ Select Day ~ Time: am     pm

Location - where were you stopped?

Officers Name: ID#: Police Agency:

Primary reason for stop: Helmet/Other, please specify:

Cite #: 1st Appearance Date: Time: am      pm

Court Location - City/County:

List any other charges issued at the same time:

If there were any criminal charges (not infractions) issued, Specify:

If you were charged with a crime you should IMMEDIATELY obtain LEGAL ADVICE!

Did the officer follow normal traffic laws in making the stop? Yes No I think so. I do not know. ~ Please Select ~
If you do not think the officer followed normal traffic laws please explain:

Did officer treat you fairly and respectfully? Yes No ~ Please Select ~
If no, please explain:

Was your helmet confiscated/taken? Yes No ~ Please Select ~
If yes, please explain:

Were you given an explanation on legal or illegal helmets? Yes No ~ Please Select ~
If yes was the explanation written, verbal or both? Written Verbal Both ~ Please Select ~
If verbal, describe the explanation:

What Happened In Court?

Have you gone to court? Yes No ~ Please Select ~
If you have NOT gone to court, when is court date?

If you HAVE GONE to court, how did you plead? Guilty Not Guilty ~ Please Select ~

If you pled GUILTY what was the fine?

If you pled NOT GUILTY, have you gone to trial? Yes No ~ Please Select ~

If you pled not guilty and have not gone to trial, when is your court date?

If you have gone to trial, what was the verdict? Guilty Not Guilty ~ Please Select ~

If you were found guilty, what was the sentence?

Fine:

Assessment: State      County      City

Work Time Hours Lost:      Lost Wages:

Briefly describe the evidence you presented at your trial (or mail a copy):

Describe the Helmet You Were Wearing

Brand: Model:

When you bought the helmet did it have a DOT sticker on the outside? Yes No ~ Please Select ~

Was the label permanenetly fastened inside the helmet? Yes No ~ Please Select ~

Was the helmet modified? Yes No ~ Please Select ~

If it was modified please describe the modifications:

Additional Information: