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This form is for use by persons who have recently been charged with an excess blood alcohol or over 80 offence in Canada. Use this form to make notes of what happened and bring this form with you to your lawyer. Keep this information absolutely confidential. WARNING! If this memorandum when completed is not delivered to your lawyer forthwith, and if it or a photocopy is seen, obtained, or seized by the police or anyone else who is not your lawyer, this memorandum could be used in Court against you. Deliver it to your lawyer in person forthwith.
