This form is for use by persons who have recently been charged with impaired driving or care and control, excess blood alcohol, refusal to blow into a roadside screening device, or refusal to blow into an approved instrument. Use this form to make notes of what you ate and drank and bring this form with you to your lawyer. Keep this information absolutely confidential. WARNING! If this memorandum when completed is not delivered to your lawyer forthwith, and if it, or a photocopy, is seen, obtained, or seized by the police or anyone else who is not your lawyer, this memorandum could be used in Court against you. Deliver it to your lawyer in person forthwith together with any notes you have made respecting your DUI arrest.

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Note: "Evidence to the Contrary" or "Evidence Tending to Show" is no longer a defence to an excess alcohol offence in Canada. The information below, will be helpful to your lawyer, in assessing the viability of some types of Charter of Rights applications and in challenges to Criminal Code of Canada section 320.31 conditions precedent.

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Private and Confidential if Completed in Full or in Part

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Drinker:

 

Witness to Drinking:

 

Drinking Date:

 

Weight and Date of Last Time Weighed? 

 

How will you document your weight?

 

 

Were you Drinking the Day or Night Before?

 

How Much and What Did You Drink the Day or Night Before?

 

Do You Drink That Much Every Day?

 

How long before the current drinking scenario was date and time when your body was last alcohol-free?

 

Were you on a specific diet?

 

Name of doctor who supervised that diet?

 

What are the side effects of that diet?

 

What has your doctor told you about the chemicals produced by that diet?

 

 

Drink #1:

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Location:

 

Arrival Time:

 

Server Name:

 

Food, Side Dish, Medication - Consumed Before:

 

Description of drink (type, brand, quantity, size, % alcohol, and details: (how was it measured, measuring device, bottle, glass size - purchase glass, ice)

 

 

 

Did you Share? How was it shared - exact procedure:

 

Time Served & Price: (keep meal/bar receipts, how did you pay)

 

Time Started: (what was on bar video, who was present, you and companion(s) should make separate notes without assistance from each other)

 

Time Finished that Drink and Pace of Drinking:

 

Food , Side Dish, Medication - Consumed After:

 

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Drink #2:

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Change of Location?

 

Arrival Time:

 

Server Name:

 

Food, Side Dish, Medication - Consumed Before:

 

Description of drink (type, brand, quantity, size, % alcohol, and details: (how was it measured, measuring device, bottle, glass size - purchase glass, ice)

 

 

 

Did you Share? How was it shared - exact procedure:

 

Time Served & Price: (keep meal/bar receipts, how did you pay)

 

Time Started: (what was on bar video, who was present, you and companion(s) should make separate notes without assistance from each other)

 

Time Finished that Drink and Pace of Drinking:

 

Food , Side Dish, Medication - Consumed After:

 

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Drink #3:

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Change of Location?

 

Arrival Time:

 

Server Name:

 

Food, Side Dish, Medication - Consumed Before:

 

Description of drink (type, brand, quantity, size, % alcohol, and details: (how was it measured, measuring device, bottle, glass size - purchase glass, ice)

 

 

 

Did you Share? How was it shared - exact procedure:

 

Time Served & Price: (keep meal/bar receipts, how did you pay)

 

Time Started: (what was on bar video, who was present, you and companion(s) should make separate notes without assistance from each other)

 

Time Finished that Drink and Pace of Drinking:

 

Food , Side Dish, Medication - Consumed After:

 

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Drink #4:

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Change of Location?

 

Arrival Time:

 

Server Name:

 

Food, Side Dish, Medication - Consumed Before:

 

Description of drink (type, brand, quantity, size, % alcohol, and details: (how was it measured, measuring device, bottle, glass size - purchase glass, ice)

 

 

 

Did you Share? How was it shared - exact procedure:

 

Time Served & Price: (keep meal/bar receipts, how did you pay)

 

Time Started: (what was on bar video, who was present, you and companion(s) should make separate notes without assistance from each other)

 

Time Finished that Drink and Pace of Drinking:

 

Food , Side Dish, Medication - Consumed After:

 

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Drink #5:

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Change of Location?

 

Arrival Time:

 

Server Name:

 

Food, Side Dish, Medication - Consumed Before:

 

Description of drink (type, brand, quantity, size, % alcohol, and details: (how was it measured, measuring device, bottle, glass size - purchase glass, ice)

 

 

 

Did you Share? How was it shared - exact procedure:

 

Time Served & Price: (keep meal/bar receipts, how did you pay)

 

Time Started: (what was on bar video, who was present, you and companion(s) should make separate notes without assistance from each other)

 

Time Finished that Drink and Pace of Drinking:

 

Food , Side Dish, Medication - Consumed After:

 

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Drink #6:

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Change of Location?

 

Arrival Time:

 

Server Name:

 

Food, Side Dish, Medication - Consumed Before:

 

Description of drink (type, brand, quantity, size, % alcohol, and details: (how was it measured, measuring device, bottle, glass size - purchase glass, ice)

 

 

 

Did you Share? How was it shared - exact procedure:

 

Time Served & Price: (keep meal/bar receipts, how did you pay)

 

Time Started: (what was on bar video, who was present, you and companion(s) should make separate notes without assistance from each other)

 

Time Finished that Drink and Pace of Drinking:

 

Food , Side Dish, Medication - Consumed After:

 

 

Bring this Form to Your Lawyer Forthwith Without Showing It To Anyone Else

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Private and Confidential if Completed in Full or in Part