FAYETTEVILLE DISTRICT COURT Preliminary Report & Information Form Defendant Information Lt Nae Ft ida Dow, ae Jue | se Sci Secuty No. | Ane Taeking# Kelly Cole F 10/27/97 2 |w |M Set Adee ay sme zip | Phone eign | we se [tie] ost) Da. amber cose Lafayette | LA, 70507 os [2m {Gm | om {ua ae of ployment Cp SR Com) | CORTE ROT UofA Student us YesO No Arrest(Offense Location Information Charges Leeson of Are ate Tine | Aneaing Agsey Careless Driving 27-51-104 Wedington / nny | o4t9 | FVD Colorado DWI 5-65-103 eet of Oia at Tine | ening Repats fe. 565-205 Wedington / 1127 | 0400 | 2017-90119 Colorado You are hereby informed that failure to appear at the stated time, place, and court shall constitute a separate offense for which you may be prosecuted and which may result in your arrest and punishment in the amount of $1,000.00 fine and/or one year in jail; I promise to appear in court on the day of 1S\December 2017 at 8:00am FAYETTEVILLE DISTRICT COURT Signature of Defendant: _ Ly WAGE 12 6 jg 176 S, CHURCH AYE. FAYETTEVILLE, AR-72701 Signature of Officer: sz Za TL. Samuels 4347 Trned Nae of Ocean Bolger Officer Notes: (On November 12, 2017, I was patrolling in the area of Wedington and Shiloh when I observed a black Toyota Tundra, bearing LAVL, €387005, traveling westbound on Wedington. Neat the intersection of Wedington and Steamboat the vehicle struck the curb on the north side ofthe street, with both passenger side tires going on top of the curb I conducted a traffic stop on the vehicle near ‘Wedington and Colorado. The vehicle pulled into the Taco Bell near that intersection. I made contact with the driver, Kelley. Kelley's eyes were red and watery. l asked Kelley to exit the vehicle and perform standardized field sobriety test. Kelley had a Medical brace 6m his right foot. I did not ask Kelley to perform walk and turn because of this brace. Kelley performed the remaining two test in a manner consistent with intoxication, During the Horizontal Gaze Nystagmus test [also observed rebound dilation present in both eyes. | asked Kelley to provide a sample for a portable breath test and he stated his parents told him not to provide a sample fora test unless he was required to do so. Kelley was placed under arrest to driving while intoxicated and transported to WCDC. Upon arrival Kelley was given to on duty DWI step officer Officer Jeney #409. Officer Jeney read Kelley the Arkansas statement of rights form and he stated and signed that he understood his rights and refused to provide a breath sample. Kelley was later requested to provide a urine sample and he agreed to do so. Officer Jeney Collected the urine sample. Kelley was given to jail staff for further processing, Revision ‘onan