Form HSMV BAR1001. Affidavit Of Refusal To Submit To Breath And/Or Urine Test - Florida

Form HSMV BAR1001 is used in Florida when an individual refuses to submit to a breath and/or urine test during a DUI (Driving Under the Influence) investigation. This form serves as an affidavit documenting the refusal and acknowledges the potential consequences of such refusal.

The form consists of sections where the individual can provide their personal information, including name, address, and driver's license number. It includes fields to indicate the type of test refused (breath and/or urine), the date, time, and location of the incident, and the signature of the law enforcement officer administering the form.

Important fields in this form include the individual's information, details regarding the refusal of the test, and the officer's signature. It is crucial for the individual to accurately fill out the required information and understand the legal implications of refusing the test.

Application Example: When a person is pulled over for suspected DUI in Florida and refuses to submit to a breath and/or urine test, the law enforcement officer may provide them with Form HSMV BAR1001. The form should be completed by the individual, acknowledging their refusal and providing necessary information.

Related Forms: Form HSMV BAR1002 is a related form that specifically addresses the refusal to submit to a blood test during a DUI investigation. Both forms serve the purpose of documenting refusal to comply with specific DUI tests, but they differ based on the type of test refused.