11/16/2022 6:40 AM FILED IN OFFICE OF TIFFANY M. RUSSELL, CLERK OF COURTS, ORANGE CO. FL
`
`)JtiS.
`
`c9P6-r (04()6i4(D
`ORANGE COUNTY SHERIFFS OFFICE
`DUI TESTING FACILITY REQUEST FOR TEST
`I, ____5(je. 7r
`35513
`
`ID #
`
`law enforcement officer employed by:
`being a duly sworn
`do hereby reauest that the on duty breath test operator of the Orange County Sheriffs • ffice administer a breath test to:
`Middle
`First
`Last
`/II
`Name:
`Name:
`Race: yi
`Ulf/ I
`DOB: 101,g_ ictfo
`-7q3-qp-qc
`
`Name: Mohlriej
`Age 3
`
`Sex:
`
`State or Country of
`Issue:
`
`Llud ,1
`l
`
`l u
`
`il
`
`1 Hilo clic('
`
`of Alcoholic Beverages, Chemical or
`
`Datoffeenosfe:
`
`Day of Week:
`
`-
`
`_
`
`t
`
`Time of
`Offense:
`
`11-1
`ceensoef: b---*" Aridei6ryi &f_/
`eSda. Y
`(7
`76-2
`Aoffiby 4 Ve._
`Orange County, FL
`Time of
`-Thesda, y
`1-16 - 20)--
`0.21,1(
`Arrest:
`Placeesto:ft/finde(44 ,s1./4 goioby hot
`Orange County, FL
`1,d-)Oego(
`NArresbteCrasec:720/2d ,fiotizeio (
`1;51.
`Was an accident involved with this immediate offense?‘424es
`0 Yes
`Was this arrest the result of a special detail?
`07,..4 No
`0 Yes
`"2 No
`Was this ajuvenile arrest?
`0 Yes
`API No
`Did this arrest result in a Parking Lot Refusal?
`
`Driver's License
`Number:
`whom I have lawfully arrested for the offense of1)1 I\
`Controlled Substance according to l :101 î (i
`u I(
`1 i_ 15.... 02.d___
`
`1 a
`0frP
`
`Date of
`Arrest:
`
`1
`
`Day of Week:
`
`Accident Case Number:
`
`Zone: (...to
`
`Zone:
`
`OCSO Depury Only:
`
`Sector:
`
`Zone:
`
`_
`
`Squad:
`
`FTEP: DYes 0 No
`
`(Affix Seal Below)
`
`Notary Public Slats of Florida
`W Denson
`cifik= Traes
`hi
`../11.1e2700"
`mXp, 4/14/20213
`
`I
`
`I 0-1809dui (02/22)
`
`015Y1at
`Enforcement Officer
`afe.—nto and subscribed before me by means of Cgl physical presence or 0 online
`notarization, this:
`i j ii bel,
`/6
`
`20 gai-
`
`Day of
`
`ei/
`
`1,,,,••••••
`
`Signature of Attesting or Notarizing Officer:
`
`67-6 I NO +19\ry
`Title
`ithersonally known 0 Produced ID
`
`ID Produced:
`
`

`

`11/16/2022 6:40 AM FILED IN OFFICE OF TIFFANY M. RUSSELL, CLERK OF COURTS, ORANGE CO. FL
`
`Implied Consent Warning
`*NOT APPLICABLE WITH VOLUNTARY CONSENT*
`(Abrneri
`DEFENDANT'S NAME: SOtt-th
`II 115 1(204
`
`DATE OF ARREST:
`
`Muni%
`
`416010
`CASE NO:, GIOdd
`(2211
`TIME OF ARREST:
`
`I am now requesting that you submit to a lawful test of your BREATH for the purpose of determining
`its alcohol content.
`
`Will you take the test?
`
`YES El NO VI
`NOTE: READ ONLY IF THE ANSWER TO THE ABOVE IS "NO"
`
`If you refuse to take the test I have requested of you, your driving privilege will be suspended for a
`period of one (1) year for a FIRST REFUSAL, or eighteen (18) months ifyour driving privilege has been
`if you have been PREVIOUSLY FINED under s. 327.35215, for refusing to
`PREVIOUSLY SUSPENDED, or
`submit to a lawful test of your breath, urine, or blood. Additionally, if you refuse to take the test I have
`requested of you, and if your driving privilege has been previously suspended, or if you have been
`previously fined under s. 327.35215, for a refusal to submit to a lawful test of your breath, urine, or
`blood, you will be committing a misdemeanor, in addition to any other penalties which can be imposed
`by law. Refusal to submit to the test I have requested is admissible into evidence in any criminal
`proceeding.
`
`Do you understand what I have just read to you?
`Do you still refuse to submit to this test?
`
`RefuSo.1
`koors es
`33o4
`NOTE: IF THE Stfalfce. POSSESSES A COMMERCIAL DRIVERS LICENSE (CDL), READ THE FOLLOWING,
`REGARDLESS OF WHEITIEt: THE SUBJECT IS OPERATING A COMMERCIAL MOTOR VEHICLE (CMV)
`
`YES 2 NO El
`YES NT NO El
`
`otor Vehicle (CMV),
`If you are a Commercial Driver Licens •
`IL) holder or were driving a Commer '
`loss of your comm -
`• riving privilege for a period of
`your refusal to submit to testing will result in
`one year from today.
`ee permanently disqualified from holding
`If this is your SECOND REFUS, o
`a CDL or operating a CMV.
`
`-
`
`'
`
`Do you understand what I
`ust read to you?
`Do you still refus-
`emit to this test?
`
`•
`
`-
`
`YES El NO Di
`YES El NO El
`
`Date read:
`
`I
`
`I Kr 140.0
`
`Time read:
`
`3001-1
`
`Location read:
`
`es4-
`
`'coo 1-4
`
`LAW ENFORCEMENT OFFICER NAME (printed):
`LAW ENFORCMENT OFFICER SIGNATURE:
`
`"Tarue
`101
`
`TO reS
`
`**EFFECTIVE OCTOBER 1, 2021**
`
`Page 1 of 1
`
`

`

`11/16/2022 6:40 AM FILED IN OFFICE OF TIFFANY M. RUSSELL, CLERK OF COURTS, ORANGE CO. FL
`
`STATE OF FLORIDA
`DEPARTMENT OF HIGHWAY SAFETY & MOTOR VEHICLES
`AFFIDAVIT OF REFUSAL TO SUBMIT TO
`BREATH AND/OR URINE TEST
`
`1,
`
`a duly certified Law Enforcement or Correctional Officer, am a
`
`DL #
`
`£00
`the offense of
`
`state of
`
`by
`
`20 2.a
`
`and I do swear
`
`SP.M.
`
`2A.M.
`
`at 10: ii
`Mu^
`LAST NAME
`
`was placed under lawful arrest for
`
`and
`
`issued citation #
`
`Torres,
`(Name of Officer reading Implied Consent Warning)
`Pt>,
`Or lekruto
`member of
`(Name of Law Enforcement Agency)
`iS
`day of NO tee mb,
`or affirm that on or about the
`Mal-tooled
`&task
`DRIVER
`FIRST NAME
`MIDDLE OR MAIDEN NAME
`1 1 3 co Ivo,
`FIDE-; cLok,
`T.Ç. TorreS
`OP /Y1 P.
`(Name of Arresting Officer)
`
`911_
`That on or about the
`in 6 cc,,,„,
`County,
`I requested that the driver submit to a Mbreath and/or Duane test to determine his or her
`informed the
`level and/or the presence of chemical or controlled substances.
`blood alcohol
`I
`driver that the refusal to submit to such test(s) would result in the suspension of his or her driving
`for a period of eighteen (18) months if
`privilege for a period of one (1) year for a first refusal, or
`his or her driving privilege had been previously suspended, or if he or she had been previously
`for refusing to submit to a breath, urine, or blood test.
`I also
`fined under s. 327.35215, F.S.,
`informed the driver that he or she commits a misdemeanor by refusing to submit to a lawful test
`if he or she
`as requested above if his or her driving privilege has been previously suspended, or
`has been previously fined under s. 327.35215, F.S., for refusal to submit to a lawful test of his or
`if he or she holds a
`informed the driver that
`I
`her breath, urine, or blood. Additionally,
`Commercial Driver's License (CDL), or was operating a commercial motor vehicle, refusal will
`result in the disqualification of the CDL for a period of one (1) year in the case of a first refusal
`or permanently if he or she has previously been disqualified as a result of.
`r- usal to submit to
`any such lawful test. Nonetheless, the driver refused to sub.. •
`-d.
`
`IS
`
`day of
`
`fq0 t/f tY034120 a.,
`
`at
`
`II ". OC 1,8113.m. CIA.M.
`
`•
`
`-
`
`-
`
`•
`
`-
`
`THE AywAyur_i_nsitExo
`Notary Public State of Florida
`Travis W Denson
`V1oZZOVO"
`1
`Exp. 4114/2026
`crurrni4SEALT ---''''
`and subscribed before
`The foregoiN instrument was sworn
`20 ag,
`t4C1 ll,
`day of
`me this LS-
`by 7. "Terres,
`who is personally known to me or who has produced
`as identification.
`N/A
`,...-00a....—
`
`—
`
`—
`
`I
`
`—
`
`Notary Public
`
`HSMV-BAR1001 (REV. 09/2021)
`
`ARWETherATTESTED
`
`Officer or Correctional Officer
`TO (s.
`F.S.)
`117.10,.fore me:
`bed
`
`g
`
`g
`
`Title
`
`r)..411111r
`
`Note: Mail or hand deliv-r
`to the designated
`Bureau of Administrative Reviews office,
`Department of Highway Safety and Motor
`Vehicles, with the driver's license, the
`appropriate copy of the UTC, and the probable
`cause affidavit.
`
`

`

`11/16/2022 6:40 AM FILED IN OFFICE OF TIFFANY M. RUSSELL, CLERK OF COURTS, ORANGE CO. FL
`
`ALCOHOL INFLUENCE FORM (Page 1
`
`Date/Time of Accident:
`11/15/2022
`
`2117
`
`Case Number:
`2022-400901
`Date/Time of Custody:
`11/15/2022
`DOB:
`Race:
`Age:
`12/08/1990 W
`31
`
`2217
`
`Sex:
`
`Law Enforcement Agency Name:
`ORLANDO PD
`AccidentNumber
`SAME
`Name (Last First Middle):
`MUNI, SARA MOHAMED
`Arresting Officer
`JOSUE TORRES
`Breath Test Operator
`T.DENSON
`Agency Inspector(s):
`K.MELVILLE
`Was subject observed for 20 minutes?
`By Whom?
`T.DENSON/
`YeS IZ
`No
`Has subject taken anything by mouth or regurgitated in the 20 minutes
`to administering the test?
`prior
`No Z
`Yes
`Date:
`11/15/2022
`Instrument Name/Serial Number:
`Intoxilyzer 8000 Series 80-001258
`Operator's Comments:
`THE DEF WAS FIRST OBSERVED ENTERING THE DUI CENTER AND STOPPED AT THE END OF THE CARPET
`WHILE THE OFFICER SIGNED IN. THE DEF WAS WEARING A SHIRT, JEANS AND SHOES. THE DEF HAS NO
`PERSONAL BELONGINGS INSIDE OF THE DUI CENTER.
`
`•
`
`Agency:
`ORLANDO PD
`Agency:
`OCSO DUI Unit
`Agency:
`OCSO DUI Unit
`
`Video Number(s):
`N/A
`
`Subject first observed at whit time?
`2245
`
`Time:
`2306
`
`Results:
`REF
`
`Instrument Location:
`ROOM# 1
`
`THE DEFS EYES ARE BROWN. THE DEF DOESN'T WEAR CONTACTS OR PRESCRIPTION GLASSES. THE DEFS
`EYES ARE BLOODSHOT AND GLASSY.
`
`THE DEF HAS AN OBVIOUS ODOR OF ALCOHOLIC BEVERAGE COMING FROM HER BREATH.
`
`THE DEFS FACE WAS FLUSHED.
`
`THE DEFS MOUTH WAS DRY AND PASTY. THE DEF HAS A YELLOWISH WHITE FILM SURROUNDING THE TOP
`LAYER OF HER TONGUE.
`
`THE DEF HAS A DAZED AND CONFUSED LOOK ON HER FACE.
`THE DEF WAS ARGUMENTATIVE WITH OFFICER TORRES STATING SHE DIDN'T PUSH THE GUY FOR
`BATTERY.
`THE DEF ASKED OFFICER TORRES MULTIPLE TIMES "WHAT IS SHE BEING ARRESTED FORTWHAT'S THE PC
`FOR YOUR ARREST?" OFFICER TORRES ANSWERED HER EVERY TIME AND AT ONE POINT TOLD HER "DO
`YOU NOT REMEMBER WHEN I TOLD YOU YOUR ARRESTED FOR DUI AND BATTERY."
`
`ON THE WAY TO THE TESTING ROOM THE DEF WAS UNSTEADY ON HER FEET SWAYING FROM SIDE TO SIDE.
`
`THE DEF WAS READ IMPLIED CONSENT FOR BREATH BY OFFICER TORRES AND REFUSED TO TAKE THE
`BREATH TEST. THE REFUSAL TIME WAS CALLED AT 2306 HOURS.
`10-1141A electronic version (11/06)
`
`

`

`11/16/2022 6:40 AM FILED IN OFFICE OF TIFFANY M. RUSSELL, CLERK OF COURTS, ORANGE CO. FL
`
`COST RECOVERY FORM
`
`•
`
`II
`
`Y7
`I4
`
`DATE:
`
`TO:
`FROM:
`
`lititor ORANGE COUNTY SHERIFFS OFFICE
`tilida0•V
`Assigned Assistant State Attorney
`Orange County Sheriff s Office, DUI Testing Center
`Reimbursernent for Cost of Investigation in the Case of
`Alun:
`(no ko,rnecl
`Defendant: S 0(-6,
`Case Number: 4204- %old I
`0 r to,Amlo
`Arresting Agency:
`PD.
`AFFIDAVIT IN SUPPORT OF INVESTIGATIVE COSTS
`T Dencon
`Before me, personally appeared
`Sheriff s Office, who first being duly sworn, deposes and says:
`The Orange County Sheriffs Office has incurred significant costs in man-hours and other
`to justice and the taxpayers currently bear this financial
`expenses to bring this defendant
`burden.
`F.S. 939.02 mandates that all costs accruing before a committing magistrate shall be taxed
`against the defendant in a criminal case upon conviction.
`3. The Orange County Sheriffs Office has incurred investigative costs, expended in the amount
`of $ q3.14
`for the processing of this criminal matter as further evidenced by the
`investigative cost expense report referenced and incorporated herein.
`In this case, the Defendant was detained/arrested for:
`)31 DUI, a criminal violation under Chapter 316, F.S.
`0 BUI, a criminal violation under Chapter 327, F.S
`0 Using a Fireann under the influence, a criminal violation under Chapter 790, F.S
`The Orange County Sheriffs Office seeks reimbursement of its costs described herein to be
`paid upon conviction, to the Orange County Sheriff s Office DUI Testing Center Fund as
`part of the defendant's sentence.
`INVESTIGATIVE COST EXPENSE REPORT
`
`SUBJECT:
`
`2.
`
`4.
`
`5.
`
`of
`
`the Orange County
`
`Date
`1.10.7.2
`
`11 (
`
`Expense Description
`DUI Testing Center Processing Fee
`D/S
`Man Hours at $ —;
`
`—
`
`Cost
`'13. 14
`
`$
`$
`
`Sworn to (or afrumed) and subscribed before me by
`means of Orphysical presence or 0 online notarization,
`this I 6" day of No vemiter, ma.),
`
`by
`
`w Enforcement/Notary
`o----Jip,-,.-
`Ea produced ID
`simally Known
`• we •
`_A-lifi
`ii Presented:
`'Tonle
`
`'Torres
`
`Signature of Arresting LEO/DUI Technician
`
`10-1554 (Revised 08/20)
`Court - Original/ OCSO Records - Copy
`
`

`

`11/16/2022 6:40 AM FILED IN OFFICE OF TIFFANY M. RUSSELL, CLERK OF COURTS, ORANGE CO. FL
`
`IN THE
`COURT OF THE
`NINTH JUDICIAL, CIRCUIT, IN AND
`COUNTY, FLORIDA
`FOR
`
`CASE NO.
`
`DIVISION:
`
`STATE OF FLORIDA
`Plaintiff,
`
`VS.
`
`Defendant
`
`ORDER FOR REIMBURSEMENT OF INVESTIGATIVE COSTS
`
`THIS CAUSE, coming on to be heard on motion of the State of Florida, pursuant to Sections
`938.27 and 939.02, Florida Statutes, for repayment of costs of investigation incurred by the Orange
`County Sheriffs Office, and this Court having found that the Orange County Sheriffs Office has
`requested and documented such costs, and that there is merit to the State's motion,
`
`IT IS HEREBY ORDERED AND ADJUDGED that the Defendant shall pay the Orange
`County Sheriffs Office the sum of $.
`The Defendant's obligation for the repayment
`of the investigative costs mentioned herein:
`
`Shall be a special condition of any court-ordered supervision; beginning on
`the Defendant shall make payments at the rate of not
`per month
`less than $
`through Community Corrections Department, Orange County Probation Unit, to be paid in full no
`later than
`2.
`
`shall
`
`shall not be joint and several along with
`FOR WHICH SUM LET EXECUTION ISSUE.
`day of,
`
`20,
`
`County, Florida.
`
`COURT JUDGE
`
`DONE and ORDERED this
`
`at,
`
`in
`
`10-1553 (5/00) White - Clerk of the Court
`
`Yellow - OCSO Records
`
`