APPLICATION FOR SEARCH WARRANT
I, the undersigned, being duly sworn, state that I have reason to believe that the Suspect and specimens
are at the location listed below.

SUCH SPECIMENS ARE SOUGHT BECAUSE:
Officers have probable cause to believe that a traffic violation under Iowa Code § 321 J.2 has occurred
and this evidence is relevant to a criminal investigation into a violation of Iowa Code § 321 J.2.

SPECIMEN(S) SOUGHT:
A blood, urine, and/ or breath specimen from the person listed below (hereinafter "Suspect").

PERSON TO BE SEARCHED:
Name:
Date of Birth:
SSN:
Other:

SUSPECT IS CURRENTLY LOCATED AT:

I have read and approved this application and request that search warrant be issued.

^"Assistant Co imt^Attop ey

The facts establishing the grounds for issuance of a search warrant are as set forth in the attachments
made a part of this application.

^/^erffce bfficer

Sworn to me this

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 ATTACHMENT A-1 - OBSERVATIONS ON SCENE
Affiant: Officer Jason Hemsted_____________
Occupation: Police Officer_________________ Number of years: J7J5_______
Assignment: Traffic Unit___________________ Number of years: J5_______
Your affiant conducted an investigation and received the following information:
I have the following training, education, and experience: I am a certified peace officer and graduate of an Iowa, regional, or
Department of Public Safety law enforcement academy. I am certified in procedures pursuant to Iowa Code §321J which included
the following training: certification to administer the Datamaster DMT breath specimen collection devices as well as the preliminary
breath testing devices; administration of the implied consent procedures; collection of urine and blood specimens and preserving
them for forensic testing; controlled drinking environments in a "wet lab” setting to test the progression of alcohol intoxication on a
person; in-field training and practice on operating while intoxicated detection; administration and scoring of Standardized Field
Sobriety Tests including horizontal gaze nystagmus, walk and turn, and one-leg stand. I use this training in my role as a peace
officer. I am also a certified peace officer in traffic enforcement pursuant to Iowa Code § 321 as are my fellow officers. Based on my
training, education, experience, and discussions with other members of law enforcement, I know the collection of a specimen for
forensic testing will aid my investigation and determine what role the use of alcoholic beverages, controlled substances, or drugs
played in this traffic offense. Based on my training, education, experience, and discussions with other members of law enforcement I
know that persons who have prior convictions for operating while intoxicated or who have been investigated for operating while
intoxicated on previous occasions are more likely to refuse chemical testing.

Based on the following information, I have probable cause to believe Suspect has violated Iowa Code §
321J.2.
Date: 08 November 2019
Time: 0213________________
Location, in Polk County, Iowa: Easton Blvd /1235 on ramp____________________________________
Road Conditions: Fair, Dry________
Information given to me by the following peace officer(s):
•
Sgt Michael Dixson_______________________
•
Officer Andrew Kilgore___________________
•

____________________________________

Suspect was operating the following vehicle:
Year: 2018_________________
Make: Ford_________________
Model: Focus________________
The following observations and conclusions for a traffic violation were made by these officers at the
scene:
The witness statement and evidence at the scene indicate that the two involved vehicles were traveling E/B on I235 at a very high rate of
speed. The driver's appeared to have been drag racing when at the I235 on ramp from Easton Blvd the victim lost control. The driver's are
friends and had spent the evening together at Shaggy's bar downtown prior to this crash. The suspect had the odor of an alcoholic beverage
coming from his breath, his eyes are bloodshot & watery. Showed signs of impairment on the HGN test (4 clues).
Officers know Suspect was operating the motor vehicle because:

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Witness identified suspect as driver. Suspect admitted to driving the car at the scene; the car is registered teethe siispect.
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The following citizens provided information assisting the officers:
•
Fopma, Jerry
DOB 08-25-75____________
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The following emergency medical technicians (EMTs) provided information assisting the officers: ~

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 ATTACHMENT A-2 - OBSERVATIONS OF IMPAIRMENT
The Suspect was transported to:
The following officer(s) are certified in Iowa Code § 321 J.2 in the same manner as Affiant. Officer(s)
made the following observations of Suspect establishing probable cause that Suspect is under the
influence of an alcoholic beverage, and / or controlled substance and / or drug:
Officer(s)
•
Sgt Michael Dixson______________________
•
Officer Andrew Kilgore____________________

Time observations began: 0230 hours_____________
/ Bloodshot eyes
/ Watery eyes
______Slurred speech
______Mumbling speech
/
Smell of alcoholic beverage coming from Suspect’s person
______Unsteady gait / unsteady balance
/
Open containers observed at scene
______Emotions visibly excited
______Judgment impaired
______Reason or mental ability affected
______Soiled clothing
Other observations of impairment: During my contact with this suspect following an accident resulting in
c~:

Suspect is currently unconscious or otherwise unable to consent.
Standardized Field Sobriety Tests (Please indicate score, refusal, or inability)
✓
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Test
Horizontal gaze nystagmus
Walk and Turn
One leg stand
Preliminary breath test results
Admission to drinking
Other:

Score / Refusal / Inability
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Refusal
Admitted to consuming 2 beers.

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Controlled Substances

______Controlled substances found
____________________________________________________
______Drug paraphernalia found
____________________________________________________
______Reasonable grounds to believe the Suspect is under the influence of a controlled substance or
drug based on the following observations:
During my contact with this suspect following an accident resulting in death I immediately smelled the odor of an
alcoholic beverage coming from the defendant's breath. The suspect had blood shot watery eyes. The suspect
admitted to drinking two Budlight beers this evening at Shaggy's bar downtown.

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 ATTACHMENT A-3 - PRIOR OFFENSE(S)
As part of our investigation, we review driving records as provided by the Iowa Department of
Transportation. We routinely rely on this database to determine if the Suspect should have enhanced
criminal charges. This database indicates the date(s) drivers have previously been convicted of
operating while intoxicated under Iowa Code § 321J.2 or similar statute of another state. A review of
the Iowa Department of Transportation database shows the following conviction(s):
Date

Iowa Courts Online Number (if known)*

County (if known)*

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*This information was independently verified on Iowa Courts Online searchable database website.

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 ATTACHMENT A-4
I know the person is the same as the PERSON TO BE SEARCHED section of this application because
the description came from another police officer, specifically:
•
•

Sgt Michael Dixson______________________
Officer Andrew Kilgore____________________

I have personally viewed this.

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 ATTACHMENT B
Officer Jason Hemsted__________________ a peace officer,
following persons who are reliable for the following reasons:

received

information

from

the

The following Informants are reliable because they are peace officers:
•
•
•

Sat Michael Dixson______________________
Sgt Michael Dixson______________________
Officer Andrew Kilgore____________________
Officer Andrew Kilgore

The following informants are reliable because they are concerned citizens with no reason to fabricate :
•

Fopma, Jerry

DOB 08-25-75____________

The following informants are reliable because they are emergency medical technicians
(EMTs) with no reason to fabricate:

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 ENDORSEMENT
In issuing this search warrant, I relied on the following:
X

1. Sworn testimony from the Affiant as reflected in Attachments A1, A2, A3, and A4.

X

2. Attachment B.

X

3. Statements attributed to the informants as outlined in Attachment B. The informants
appear reliable for the following reasons:

The following Informants are reliable because they are peace officers:
•
•
•

Sgt Michael Dixson______________________
Sgt Michael Dixson______________________
Officer Andrew Kilgore
Officer Andrew Kilgore

The following informants are reliable because they are concerned citizens with no reason to fabricate:
•
•

Fopma, Jerry

DOB 08-25-75____________

____________________________________

The following informants are reliable because they are emergency medical technicians
(EMTs) with no reason to fabricate:

I FIND THE INFORMATION ABOVE ESTABLISHES PROBABLE CAUSE TO BELIEVE THAT THE SUSPECT
COMMITED A TRAFFIC VIOLATION UNDER IOWA CODE §321J.2. THE SPECEMIN(S) REQUESTED IS
RELEVANT FOR AN INVESTIGATION INTO A VIOLATION OF IOWA CODE §321J.2.

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