Form Dl-5 - Texas Residency Affidavit printable pdf download

Texas Residency

Affidavit

Instructions for completion are on back of form

To be eligible for a Texas driver license or identification card, the applicant must be a resident of or

domiciled in Texas. If the applicant cannot provide two acceptable residency documents from the list

found on the back of this form, this affidavit may be used as evidence of residency in Texas.

Texas domicile rules are in the Texas Administrative Code (37 TAC §§ 15.49 and 16.15).

The applicant for a Texas driver license or identification must complete Section A.

A. Applicant Information

Name

Residence Address

City

State

ZIP Code

I certify that the information provided above is true and correct. I understand that according to Texas

law, it is a crime to knowingly make any false statement relating to the application for a driver license or

identification card.

Applicant’s Signature

Date

A representative who provides services to the applicant at the address in Section A must complete

Section B certifying that the applicant resides or receives services at that address.

The individual certifying the applicant’s address in Section A must complete Section B and provide two

acceptable documents establishing proof of residency. If the individual who completes Section B is not

related to the applicant, they must accompany the applicant and submit this affidavit in person.

B. Individual or Representative Information

Name of Individual or Representative

If a representative, please provide the affiliate organization

Business or Residence Address

City

State

ZIP Code

The applicant and the individual or representative must sign Section B.

The individual or representative for the applicant must certify and sign the following section. I certify the

information submitted on behalf of the above applicant is true and correct. The applicant does live at

my residence or receives services at the location listed above. I understand that according to Texas law,

it is a crime to knowingly make any false statement relating to application for a driver license or

identification card.

Certifier’s Signature

Date

DL-5 (00-0112)

Form Dl-5 - Texas Residency Affidavit