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BEFORE ME, the undersigned authority, personally appeared ________________________________, who made
(PRINTED NAME OF APPLICANT)
this Affidavit and, on oath, stated the following:
“I hereby authorize the release of information and records pursuant to Section 411.174(a)(9) of the Texas
Government Code, to the Texas Department of Public Safety for the purpose of a background investigation to
determine my eligibility for a license to carry a concealed handgun or to instruct applicants for such licenses.”
“Such records may include, but are not limited to:
1. All records, reports and testimony relating to the medical condition of an applicant or license holder for use
as allowed pursuant to Section 12.097, Texas Health and Safety Code;
2. Child support payment status as evidenced by court documents or records from the Office of the Attorney
General;
3. Payment status of taxes or other money collected by the Comptroller, State Treasurer, tax collector of a
political subdivision of the state, Texas Alcoholic Beverage Commission, or any other agency or subdivision
of the state, as evidenced by tax or agency records;
4. Files and records of the juvenile court relating to applicant pursuant to Section 58.003(m), Texas Family
Code;
5. Law enforcement records, including offense or arrest reports;
6. Current restrictions under a court protective order;
7. Court documents reflecting pending charges or final dispositions.”