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New York Codes Rules Regulations (Last Updated: March 27,2024) |
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TITLE 22. Judiciary |
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Subtitle D. Forms |
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Chapter VI. Forms for Use in Courts Exercising Criminal Jurisdiction |
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6a Nav. L. chemical tests—affidavit |
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Sec. 49 Nav. L. Form 6-A (Nav. L. Chemical Tests-Affidavit) 3/90 __ Court of __ County of __ ___________ x In the Matter of the Application of Indictment/Docket _______ , No. __ [name of applicant] AFFIDAVIT for an order to compel _______ [name of arrestee] to submit to a chemical test, pursuant to Nav. L. § 49 ___________ x STATE OF NEW YORK ) ) ss.: COUNTY OF __ ) _________, being duly sworn, deposes and says that: [name of applicant] 1. I am a [police officer employed by the ] [district [name of police department] attorney as defined in CPL § 1.20(32)] [peace officer acting pursuant to his or her special duties]. At [time] [a.m.][p.m.] on, [date] 19, I placed [name of arrestee] under lawful arrest for violating subdivision(s) __ of section 49 of the Navigation Law. I make this affidavit in support of an application for an order to compel the arrestee to submit to a chemical test, pursuant to section 49 of the Navigation Law. 2. I have reasonable cause to believe the arrestee was the operator of a vessel as defined in section 49(4)(a)(3) of the Navigation Law, because . In the course of such operation a person other than the operator [was killed] [suffered serious physical injury or personal injury as defined in section 10.00 of the Penal Law, in that said person (describe nature and extent of injuries) ]. 3. A breath test administered by a police officer in accordance with section 49 of the Navigation Law indicates that alcohol has been consumed by the arrestee. – OR – Based on the totality of the following circumstances, there is reasonable cause to believe that the arrestee was operating a vessel in violation of subdivision 4 of section 49 of the Navigation Law (describe specific circumstances indicating violation) . 4. After being placed under lawful arrest, the arrestee refused to submit to a chemical test in accordance with the provisions of section 49 of the Navigation Law, by (describe circumstances of refusal) . – OR – After being placed under lawful arrest, the arrestee is unable to give consent to a chemical test in accordance with section 49 of the Navigation Law, because (describe incapacity) . WHEREFORE, it is respectfully requested that the Court issue an order requiring the arrestee to submit to a chemical test to determine the alcoholic or drug content of his/her blood and directing a person authorized by section 49(4)(e)(1) of the Navigation Law to withdraw a blood sample from the arrestee for the purpose of determining the alcoholic or drug content thereof. Deponent Sworn to before me this __ day of __, 19. Notary Public |