DUI Incident Clarification and Correction Statement Template

[Your Full Name]

[Your Street Address]

[City, State/Province, ZIP/Postal Code]

[Phone Number]

[Email Address]

[Date]

[Name of Court / Agency / Office]

Attn: [Judge’s Name / Prosecutor / Probation Officer / Hearing Officer / Evaluator, as applicable]

[Street Address]

[City, State/Province, ZIP/Postal Code]

1. Case Information and Purpose of Statement

Re: DUI Case [Case Number] – Clarification and Correction Statement Regarding DUI Incident on [Date of DUI Incident]

I, [Your Full Name], am submitting this statement to clarify and correct certain information previously provided or recorded in connection with my DUI incident on [Date of DUI Incident] in [City, State/Province]. The purpose of this statement is to identify information that was inaccurate, incomplete, or unclear, and to provide corrected or updated information in an organized format.

2. Reference to Prior Statement(s) or Document(s)

This clarification and correction statement refers to the following prior document(s) or statement(s), where I believe corrections or clarifications are necessary (check or describe as appropriate):

• Police report dated [Date of Report] prepared by [Officer’s Name / Agency]

• My prior written statement dated [Date of Prior Statement]

• Court document or form (name or description): [Description]

• DUI evaluation or assessment form completed on [Date]

• Other: [Describe any additional document or record]

Police report dated [Date of Report] prepared by [Officer’s Name / Agency]

My prior written statement dated [Date of Prior Statement]

Court document or form (name or description): [Description]

DUI evaluation or assessment form completed on [Date]

Other: [Describe any additional document or record]

If specific page, section, or paragraph numbers apply, list them here:

[Example: “Police Report, Page 2, Paragraph 3”; “Evaluation Form, Question 10.”]

3. Clarifications and Corrections to Factual Information

Below are the specific items I wish to clarify or correct. For each item, I have listed the original or inaccurate information and the corrected information, along with a brief explanation if needed.

Item 1

• Original / Inaccurate Information:

  [Quote or summarize what the earlier document or statement said, as accurately as you can.]

• Corrected Information:

  [State the correct information clearly and specifically, including accurate dates, times, locations, names, or details.]

• Explanation (if needed):

  [Briefly explain why the original information was incorrect or incomplete — for example, a memory error, misunderstanding of the question, or later review of records.]

Original / Inaccurate Information:

[Quote or summarize what the earlier document or statement said, as accurately as you can.]

Corrected Information:

[State the correct information clearly and specifically, including accurate dates, times, locations, names, or details.]

Explanation (if needed):

[Briefly explain why the original information was incorrect or incomplete — for example, a memory error, misunderstanding of the question, or later review of records.]

Item 2

• Original / Inaccurate Information:

  [Original description or text.]

• Corrected Information:

  [Corrected factual information.]

• Explanation (if needed):

  [Short explanation, if helpful.]

Original / Inaccurate Information:

[Original description or text.]

Corrected Information:

[Corrected factual information.]

Explanation (if needed):

[Short explanation, if helpful.]

Item 3

[Add additional numbered items as necessary. Use as many items as you need to address each separate correction or clarification.]

4. Additional Context or Clarifying Details (Optional)

In addition to the specific corrections above, I wish to provide the following context or clarifying details about the DUI incident or related events, to the extent that they may help create a more accurate record:

• [Example: Clarification about the exact time you left a location, weather or road conditions, or who was present in the vehicle.]

• [Example: Clarification about your physical or medical condition, or any confusion about instructions you received.]

• [Example: Any other factual detail that was missing or unclear in prior documents.]

[Example: Clarification about the exact time you left a location, weather or road conditions, or who was present in the vehicle.]

[Example: Clarification about your physical or medical condition, or any confusion about instructions you received.]

[Example: Any other factual detail that was missing or unclear in prior documents.]

This section is optional; you may leave it blank if all necessary information is already covered in Section 3.

5. Supporting Documents (If Any)

To support the corrections and clarifications above, I am able to provide, or have attached, the following documents (if available and appropriate):

• [Example: Copy of time-stamped receipts, phone records, or GPS logs.]

• [Example: Medical records or letters from a healthcare provider.]

• [Example: Employment records, school schedules, or other documents that confirm dates and times.]

[Example: Copy of time-stamped receipts, phone records, or GPS logs.]

[Example: Medical records or letters from a healthcare provider.]

[Example: Employment records, school schedules, or other documents that confirm dates and times.]

If you are attaching documents, you may label them as exhibits, such as:

• Exhibit A – [Description]

• Exhibit B – [Description]

Exhibit A – [Description]

Exhibit B – [Description]

6. Statement of Good Faith

The information in this clarification and correction statement is provided in good faith and to the best of my knowledge and recollection. My intention is to make the record of my DUI incident as accurate and complete as possible. I understand that this statement may be considered along with other evidence and documents in my case.

7. Certification and Signature

I certify that the information in this DUI Incident Clarification and Correction Statement is true and correct to the best of my knowledge and belief as of the date below.

[Your Signature, if printed]

[Your Printed Name]

[Date]