Address And Business History Form, Chl-78b, 2015
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1Texas Department of Public Safety
HANDGUN LICENSING
Regulatory Services Division
ADDRESS AND BUSINESS HISTORY FORM
AppLICANT NAME
RESIDENCE HISTORY INFORMATION
(*LIST ALL ADDRESSES LEADING UP TO THE RESIDENCE LISTED ON CHL-78)
You are required to provide all addresses for a full five years (60 months) preceding the date of this application (e.g. 04/2005 to
04/2010), with no gaps and explaining any overlaps by attaching a written statement.
DATE RANGE(S)
ADDRESS(ES)
(MM/YYYY)
(MUST BE COMPLETE ADDRESS INFORMATION FOR EACH ITEM)
FROM
Address
(BEGAN)
TO
City
State
Zip
(ENDED)
(2-Letter Code)
FROM
Address
(BEGAN)
TO
City
State
Zip
(ENDED)
(2-Letter Code)
FROM
Address
(BEGAN)
TO
City
State
Zip
(ENDED)
(2-Letter Code)
FROM
Address
(BEGAN)
TO
City
State
Zip
(ENDED)
(2-Letter Code)
FROM
Address
(BEGAN)
TO
City
State
Zip
(ENDED)
(2-Letter Code)
FROM
Address
(BEGAN)
TO
City
State
Zip
(ENDED)
(2-Letter Code)
EMpLOYMENT HISTORY INFORMATION
(*LIST ALL ADDRESSES LEADING UP TO THE EMPLOYMENT LISTED ON CHL-78)
FROM
Employer
(BEGAN)
Name / Address
TO
City
State
Zip
(ENDED)
(2-Letter Code)
FROM
Employer
(BEGAN)
Name / Address
TO
City
State
Zip
(ENDED)
(2-Letter Code)
FROM
Employer
(BEGAN)
Name / Address
TO
City
State
Zip
(ENDED)
(2-Letter Code)
FROM
Employer
(BEGAN)
Name / Address
TO
City
State
Zip
(ENDED)
(2-Letter Code)
FROM
Employer
(BEGAN)
Name / Address
TO
City
State
Zip
(ENDED)
(2-Letter Code)
CHL-78B (Rev. 12/15)
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