BREATH TEST ADMONITION DR#(Required) Date MM slash DD slash YYYY The breath testing equipment does not retain any breath sample for later analysis by you or anyone else. If you want a sample to be retained, you may provide a blood sample that will be retained at no cost to you. If you do so, the blood sample may be tested for alcoholic or drug content by either party in a criminal prosecution.Arrestee(Required) Officer WATSON ADVISEMENT You are also advised that being under the influence of alcohol or drugs, or both, impairs the ability to safely operate a motor vehicle. Therefore, it is extremely dangerous to human life to drive while under the influence of alcohol or drugs, or both. If you drive while under the influence of alcohol or drugs, or both, and as a result, a person is killed, you can be charged with murder.Arrestee SignatureRefusal to sign Check box if person refused to sign. Arrestee Read By Enter email address to send this completed form to:(Required)