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JUSNCE COURI1
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THE PEOPTE OF THE STAIE OT
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COURT
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M !l.v (6/17)
RECEIVED
this ltqort ofRcfusal to Submit to a Chcmical Tcst is bcing issucd in accordancc with:
Eficction 49-a of tlc Navigation l-aw (for vcsscls) - OR - .iut I 5 202t
E Scction 25.24 of tlrc Parks, Recreation and llistoric Prcscrvation Law (for snowmobilcs)
Keep gtoon copy; tum In goldenrod, whlte & plnk coplo8 to tho courl rt the analgnment; brlng the yallow copy lo th! Motor Vchlcllt hrlrlng.
Affer lhe srtalgnment, keop tho pink copy foI court recor&. Wthln 48 hours of the analgnmont, lond tho whlt6 copy, aloog wllh I copy
ofthe'Notlc€ of Temporary Suspension and Notlco of H6srine-Vossol/Snowmoblle' (AA.137V) lo th6 Dop!(m6nl ol Motor Vohlclor,
Safety Hearing Bureau, 6 Empke State Plaza, Albeny, NY 12228. Sond the Oold€nrod copy to th6 Ofilco of Prrt!, Rccroetlon & l.ll.tortc
Presorvation, Bureau of Marine & Recroatlonal Vehlcles, Agency Bulldlng Ono, Emplre Stsle Plaza, Albany NY 12238'0001,
yearof 2'tLL( at
l;liili,?::i" \ n{rrh,,Jpz Q_,\;*r,.. Name a.nd P.ank of @cer civrng Warnrno I W,tnessinq netusat r,iirnoiirres ilTJ
Number
Ta( Registry J
Anilr
Tax Registry
L^ \trh. Dcn'/nl
Number I- ----=t--_lf-
(NYC only) (MYC only)
Pleasc clred gll appropriatc boxcs ort tlrir prgc, Proes hard; you ere maklng I ooplot,
RECEIVED
Thic Repn of Rcfusal to Subn'iit to n (lhcnrir:nl 'l'cnt ir, bcing issued in accordrncc witlr:
El'iection 49-a of thc Navigttion taw (lirr vcsscls) - OR - ,JUl_ I 5 20?t
EI Scction 25.24 of thc Purks, ltccraotion and t listoric l'rcscryntion Law (lbr rnowrnobllcs)
Keep groon copy; tum ln goldonrod, whltc & plnk coploa to tho courl .l tho lrralonment; bdng tho ycllow copy to th6 Moior Vehlclcr hoadng.
Afler the arralgnmcnt, kocp tho plnk copy for court rocords, Wlthln 48 houra of tho rrralgnmont, osnd ths whlto copy, tlong wllh r oopy
of the "Notlce of Tomporery Surpenalon and Notlce of Hearing-Voacol/Snowmobllo" (AA-137V) to the D6partmeni of Molor Vehlclca,
Safety Hoaring Bureau, 6 Emplre Stato Plaza, Albany, NY 12228. Send the goldonrod copy to tho Ofilce of Parka, Rocrcrtlon a Hlrtorlc
Preservation, Bureau of Marlno & Recreatlonal Vehlclos, Agency Bulldlng Ono, Emplro Stato Plaza, Albany NY 12238.0001 ,
\,
i ,1 'j
Operator's Nane DateofBlrth Sox:EM trr
Address : State r' ZlpCode
Registratlon or D0cument No. of VesseUSnowmoblle (or Hull lD No.Nohlcle lD No., lf not avalhblc) .nd lssulng Agoncy
year ol at
' (SpcdflCLocetlon)
he/she arrested the above operator on a charge of violating:
and impairment or intoxication (such as poor coordination, alcoholic beverage odol etc.-give details).
No compulsory chemical test was administered, pursuant to E Section a9-a(8) of the Navigation Law D Section 25.24(7) of the parks,
Recreation and Historic Preservation Law.
Name and Rank of Name and Rank of Oflicer Giving Warning & Witnessing Refusal (lf not arresting officer)
Arresting Officer
Tax Regist'y Number Tax Registry Number
(NYC Only) (NYC Only)
Police Precinct Police Precinct
Agency No. Agency No.
Signature )ate Signature )ate
) t,t ) I I
FALSE STATEMENTS MADE IN THIS REPORT ARE PUNISHABLE AS A CLASS "A'' MISDEMEANOR UNDER SECTION 210.45 OF THE PENAL LAW
S1'A'I'Ii OF NIiW YOITK (:oLJNl'\' Ol; SAltAl'(X;A
1'O\\/N OI; MAt-l_A .IIISTICIi COL'ITT
I]LAKI! A, IIEFLIN
Dcfcndnnl,
PI-ltAsE TAKE NorlcE, thal upon rhe anncxed alfirmalion and all thc prior papcrs and
proceedings herein, thc undcrsigned rvill movc rhc Malts .l-own court, on the ii ,day of Luty, zoz
t
or as soon thereafter as counsel can bc hcard, lor an order pursuant to scction 170.20(2) ol'ihc
Criminal Procedure I-aw removing thc proceedings conccrning rhe nrisdemeanor charges against
the abovc'named dclendant so that said chargcs nra1, bc presentecl to a grand jur1,, and lbr
such
other rcliel'as the Court deems pr-oper.
KAIT-EN A. HEGCEN
IJA\\}i M. I,F]SC
25 \\/csr I{igh Sr rccr
ISallston Spa, NY I
(s l8) 885-2263
BLAKE A. IJEFI-IN.
Delbndant.
SI{AWN M, LESCAULT, art attonrcy duly adnrittcd lo practicc in thc Courts olthis Srorc,
hereby alfirms under pcnalty ofperjury that thc following stalernents arc lruc, and as to thosc nradc
l. I am an Assistant Districl Attorney in thc office of the Dislricl Alromey lbr Sararoga
County.
on July 6, 2021, charging thc above-named Defendant with tJoating Whilc Intoxicated in violarion
i. No plca ol'guiltl' has been entered \\'ith respccl to the alorementioued chargc or anv
4. The f)istrict Attorney intends to present lhc misdemeanor charge (and/or additional
felony charges) against the Defendant to a Crand Jury with a view toward prosecuting by indictnrenr
in superior court.
WHERIFORE, the District Attomey requests that this Coufi issue an order adjouming the
proceedings ofthe aforesaid charges so that said charges may be presented to a grand jury with a
vic\\'lo procccding by indictnrcnl in supclior court, rnd lirr such othcI and Ihrthcr rclicl'as lhc cr:u11
SharVn M, Lcscaul