g\‘g@bl»oz § //;,2@'/< __?:O-‘*__LQ@M_¢>,T'_@ F Q ormn l, AWE»;¢/ § Cow.>:r 0 145er ~ /QGEL ACO§TA F@/"\? :TE@{)_FLL f,-. di .-.'MA./J 4 °°"RT°FCRNINMAPPEALS '7?`/% 420 wiZ-BI,SQC{~OB NOV3[l 395 72 pr ,Jo wzo»@¢>g@c¢¢v 63 B_ m»-Ama-¢, , ,e;k__ `DE/<\(a ma r-\&EL A<;o.sw\, -1”1/£ E,\/z“ /@(//E 577¢)7/-73 CiqusL/’. 00 /Ym@cH a 0101§ 7’//¢’5 CO¢ Le&s£__&e;$@/___/_Hese;;xzm__ LJI-rH -r/¢z; mom/d 7’0 &mp£/ 771 7#€ (_\uu 27 >SJC/ME®.‘ 77/4,\//6 §/0¢,¢ @) .;/'EQQELL, `szTMA/J §ZBZ€_£HQ;T ,5(¢ l(’ ` F/ '70/.:201 @) -317 [z . g¢mf' Errfm' 57 ` ¢@,) fw c _$THTE marr (,i L 735 flag/af steam /~MSE/ /46057/-\. ma nro,<'}`n: Cm¢m \\,/m,L p)E/<_)s§ f-’:/¢.' vwzs /m,~;@_) r-x.m PQ/»:/,ZW_, j"/ 70 /2051 TE€€LL G~ b:fY///MA/ y _' ` _'_ -` l _` 1 __" ___ _ "'\. _ , - 1 ._ _ `__r am "o.f..Arre_'-S'tee_' ~~J C`-'%""“\"\_~’ \><< ’»~Fl" ‘ 'C\»l-;_):'-T(_(,.L) ._”_~;s __ ,_ v :.. ,- - r`]; y l v ' _ _` .¢`_4"_ _ l \' v `},`tv{l (-,~ `1\{{`\1:¢§,"5“(§_..'.:l ( c.".\:~;l_';~`-. ,* `~'\T"_`..`J_-\':\il C\"“,» . 1 ` ' §) " del / 10 `_/1‘>‘"`1 lursuan_t t`o th§_ pr0v1slons of]'ex. Transp. C`ode An'n_. §724 _0_12, th`e_ undersigned peace officer requlr§s that rl_< Transp C_od_e_ Ann Ch. 7_2_4, subch B._ 'Act__i_ng__ _in my capaclty as a peace ofhcer l have arrested the abo named person for an offense under~_=v _' Chapter 49 of _th "~"'»'»)xa_s P_ena`l Co_d§; _su h__person \fz.:as the operator _otor_vehlcle or wate ff“_ nv`olvéd-’ -_ '_j' ` 'f_n an accldentt reasonab_ `jbelleved occurred a _a result fthe offense h`"en | :arrest_ed»t =abov`§'- arned;__~- _- _ _ _ person`, l_ reasonably believed fat another person led died or 'd_ul_d die as; a result of _t_h_e accldent,_ and `t'he'-*-'-" ` " l :above_- named person has prior _t_o‘ h_e',-i' 1_ssu_anc_e_ of this order refused my request -_to voluntarl|y glve an appropnate - __ l _-_`,_ spec1men or spec1mens un_d_e__r th authorlty o__f Tex.- Transp C_`_od Ann Ch 724" '_. ' _ _ " Thls request ls made _pu_r_su _ ;,§7__24 12_f yo_u_ t__o_ cqucre a spemmen §r_ specimens:._ ' the -€§.Ov._e~_n'amed_zarreste§'-s v ___peace off1cer nd as such under'the provls1_` ' `.-»hlame o.ffP§_rson` Form.zDelivered__fo ‘=C-'-"`"-lf/_'l.c;~> § ' "»`_. 1 ‘ ' . ':|D_ate n _ _ _ _ - `»`~.~` `_'. -__,\ . ll ' C`. '>"’ ’ `) l’\h lf',-:;;\\ ':`\\ l \ l l"'\‘~;("(_:l lCO l ' Time and Pla§e ` ’ - ' `:'\) g`\/\"/\\\,\(,\in `,: ,` "[,`ll l\(-\ - ;': -|=;"[\-?.l Nar`ne~.and Ocou_pation_ of Person Obtainlng_"$peclmen ._,.... ...»‘n»~*"" DR|_V|NC WMlLE lNT_OXlCRTED_ CASES_ v ;1;/\.' 1 2 RL’D "/11@,¢ 1501 EV' ~ 11900592 - .'1" " - LC DEPARTMENT ._ ' ' BLo`o_o ANA `Ysls REL llllllllll Wlmllllll l LJM:\:1 oHoL __ __ _ Where Sample Depos1ted ' _`-'--AE l/_l_ N\\l') :.' . l ~ Person Deposltmg Sample l 2 ` " ' 7 Name Tl@gb}/ZM/¢€ Agency M[$@l///C 90 For laboratory personnel only AGENCY 113 012?0_‘/;>€>_ __ ~§L_I- 51 ores/AI/B@ . __ mae z,'_éf"l?z 1 _ '..l;\ `~¥`)V<`:l AEF|D}\V|