NOTICE TO OFFICER AT ROADSIDE STOP
As required by Pennsylvania law, I am herewith tendering my driver's license and proof of insurance. They are in proper order, and I have committed no crime or traffic violation. I therefore hereby request that all my documents (including my license) be returned to me and that I be permitted to leave immediately. If you have any doubt about my ability to operate my vehicle, I will be glad to leave my car here and have a cab pick me up. Unless you return these items to me and advise me that I can leave with my license and other documents and in my vehicle, I must assume this is more than a brief investigatory stop, that my liberty is restrained, that I am under arrest, and that I must obey your orders without resistance, but I do so under protest.

I do not wish to answer any questions or make any statements at this time. I am exercising my right to remain silent. (U.S. Constitution, 5th Amendment) I request that my attorney be present during any questioning or proceeding against me (including voluntary field sobriety exercises) and that I be permitted to contact my attorney at the earliest possible time, as permitted by Pennsylvania and federal law. I have the name and phone number with me at this time and would like to call him immediately.

Pennsylvania law does not require me to submit to any verbal or non-verbal field sobriety evaluations, including reciting the alphabet, the horizontal gaze nystagmus evaluation, the Alco-sensor (hand-held breath testing device), walk-and-turn, one leg stand and other such exercises. Therefore, I choose not to participate in any such so-called field sobriety evaluations, unless my attorney is present when such voluntary exercises are performed. If you ignore my Constitutional and statutory rights under this card and verbally coerce me into taking any such evaluations, I am not performing any such exercises willfully and voluntarily, but am doing so to avoid a confrontation with you, and armed law enforcement officer.

In compliance with the requirements of Pennsylvania's Implied Consent Law, I will consent to submit to tests of my breath, urine, blood or other bodily substance which you may designate, provided the test I am offered is properly done in strict compliance with all regulatory and statutory provisions and by a person certified to give the test, after such person has displayed his/her permit, and conditioned upon the test and testing device used being properly approved by the State of Pennsylvania. However, since I maintain that you do not have reasonable or legally sufficient cause to make this request for a chemical sobriety test, my consent is given under protest and is in no way voluntary. Furthermore, I do not waive any deficiencies in the advisements you are giving me, or in the procedures that you follow. I wish to be given a copy of the implied consent rights, which you read, to me. Any consent by me to take a chemical sobriety test is given only for device, which are operated, with all electronic and operating components prescribed by the machine's manufacturer properly attached and in good working order and where all pre-testing protocol and recommended observation period are followed precisely. Otherwise, my consent is not voluntarily given.

I request that I be provided with full information concerning your test including a written copy of any report of the results of your test. If it issued, I wish to view any digital or numerical readout on the breath machine, pursuant to my Constitutional rights to confront witnesses and evidence against me. I also desire to have an independent analysis made of any chemical tests taken by the State of my blood, breath or urine, and hereby demand that a sufficient sample of my blood, breath or urine be collected and properly sealed, and immediately refrigerated to prevent deterioration of the sample so as to permit re-analysis to be accomplished at a later date. Please honor this request for preservation of a sample by selecting a machine or type of test that can preserve a sample. In addition, if a breath machine is used, I request that the machine go through its diagnostics check before I am test ed, to be certain that it is operating properly before my tests are administered. If a test result(s) is obtained, immediately after my testing is completed, I request that a calibration check be made on the machine to determine if it is calibrated accurately (against a known-strength alcohol reference sample). Please replicate all calibration tests and provide me with proof of the calibration results.

If, after the administration of your test, you decide to charge me with any DUI offense under Pennsylvania Law, then I request that I there upon be transported to the nearest available private medical facility which will conduct independent testing. I wish to be independently test ed even if your test fails, or does not yield a numerical result. If feasible, I will select and utilize my own physician or medical provider to administer my independent test (s). I will make my own financial arrangements upon arrival at the selected facility, will select the type of test I want and I specifically request immediate access to a phone and phone directory to arrange this. This request should also no be considered to withdrawn or waived even if I take one or more additional breath tests.

I also hereby request that I be taken to the nearest law enforcement agency (which is not affiliated with your agency) that possesses an approved breath machine (Intoxilyzer 5000) so that I can be given an independent breath test by an officer other than you or someone employed by your police department. I will pay for this test if there is a charge for conduction it. Any and all tests selected by me (both breath and blood) are being done as work product for my attorney, and are confidential, as guaranteed by the attorney-client privilege and pursuant to my Constitutional right to gather evidence in my defense. I do not consent to any independent sample being divided or collected for use by the State, nor do I consent to copies of test results being given to anyone except myself or my attorney.

I object (and do not consent) to a search of my person, my motor vehicle or any of my other property. Unless I give you written authority to search my vehicle (for inventory or any other purpose) and arrange for impound of my vehicle, I wish for my vehicle to remain at its present location, locked, with a note explaining that it will be removed as soon as possible, and I will arrange for a private tow of the vehicle as soon as I am provided access to a phone through your instructions. I hereby release and indemnify your police department from all liability resulting from leaving the vehicle at this location at my request. I also do not consent to being videotaped or audiotaped at any time without my written consent, as such unauthorized taping would constitute a violation of my right of privacy under the Pennsylvania Constitution and the United States Constitution.

This document constitutes an official notification, which should be retained for your records.