Form Chl-88 - Revocation Affidavit - Texas Department Of Public Safety printable pdf download

REVOCATION FORM

OFFICER’S AFFIDAVIT FOR REVOCATION OF CONCEALED HANDGUN LICENSE AND/OR INSTRUCTOR’S CERTIFICATE

UNDER GOVERNMENT CODE SECTION 411.186

STATE OF TEXAS

COUNTY OF ____________________

BEFORE ME, the undersigned authority, personally appeared _____________________________________, known to me to be

a credible person, who being duly sworn, deposed as follows:

My name is _______________________________________________________, and I am a Texas Peace Officer employed by

__________________________________________________________, Identification No. ___________________________.

The license holder’s name is ___________________________________, Concealed Handgun License No. _________________,

Instructor Certificate No. __________________________; TDL No./Texas Identification No. _______________________, whose date of

birth is ____________________, who resides at ___________________________________________________________________, and

whose phone No. is _____________________________.

I believe that the following grounds exist to revoke the license to carry a concealed handgun or certificate as a concealed handgun

instructor:

1.

The license holder was not entitled to the license at the time it was issued for the following reason(s):

____________________________________________________________________________________________________

2.

The license holder gave the following false information on the application:

____________________________________________________________________________________________________

3.

The license holder became ineligible for a license, based on the following reason(s):

____________________________________________________________________________________________________

4.

The license holder was convicted under Texas Penal Code §46.035, Unlawful Carrying of Handgun by License Holder, in Cause

No. ________________ in the ______________ Court of __________________________ on _________________ __________.

5.

The license holder has previously been suspended twice for the following reason:

____________________________________________________________________________________________________

YES

NO

Was the license surrendered to officer?

IF LICENSE WAS SURRENDERED TO OFFICER, PLEASE SEND LICENSE TO: REGULATORY SERVICES DIVISION

MSC 0245, TEXAS DEPARTMENT OF PUBLIC SAFETY, PO BOX 4087, AUSTIN TX 78773-0245.

THE FOLLOWING EXHIBITS ARE ATTACHED TO THE AFFIDAVIT AND INCORPORATED BY REFERENCE:

____________________________________________________________________________________________________

__________________________________________________

SIGNATURE OF PEACE OFFICER/AFFIANT

AGENCY ADDRESS:

AGENCY PHONE No.:

SUBSCRIBED and SWORN TO before me, this ____________ day of ______________________, 20______.

__________________________________________________

NOTARY PUBLIC in and for the State of Texas

PEACE OFFICER: 1. SEND AFFIDAVIT ALONG WITH ATTACHMENTS WITHIN 5 DAYS AFTER THE AFFIDAVIT

IS PREPARED TO: REGULATORY SERVICES DIVISION MSC 0245, TEXAS DEPARTMENT OF

PUBLIC SAFETY, PO BOX 4087, AUSTIN TX 78773-0245

2. SEND COPY OF AFFIDAVIT AND ATTACHMENTS TO LICENSE HOLDER

CHL-88 (Rev. 4/10)

Form Chl-88 - Revocation Affidavit - Texas Department Of Public Safety

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