Form 50-284 - Request For Confidentiality Under Tax Code Section 25.025 Page 2

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Form

Texas Comptroller of Public Accounts

50-284



Juvenile Probation or Supervision Officer

Texas Civil Commitment Office

A current or former juvenile probation or supervision officer certified by

A current or former employee of the Texas Civil Commitment

the Texas Juvenile Justice Department, or the predecessors in function

Office or of the predecessor in function of the office or a divi-

of the department under Title 12, Human Resources Code.

sion of the office.



Medical Examiner or Forensic Analyst

Texas Department of Criminal Justice

A medical examiner or person who performs forensic analysis or testing who

An employee of the Texas Department of Criminal Justice.

is employed by this state or one or more political subdivisions of this state.



Texas Juvenile Justice Department



Peace Officer

A current or former employee of the Texas Juvenile Justice

A current or former peace officer as defined by Code of Criminal

Department or of the predecessors in function of the depart-

Procedure Article 2.12, the spouse or surviving spouse of a current or

ment.

former peace officer or the adult child of a current peace officer.



U.S. Attorney or Assistant U.S. Attorney



Sexual Assault, Abuse, Stalking or Trafficking of Persons

A current or former U.S. attorney or assistant U.S. attorney and

An individual who shows that the individual, the individual’s child or

the spouse and child of the attorney.

another person in the individual’s household is a victim of sexual assault

or abuse, stalking or trafficking of persons.



U.S. Criminal Investigator

Refer to section 3 for required documentation to be provided with this

A U.S. criminal investigator as described by Code of Criminal

request.

Procedure Article 2.122(a).



State Judge

U.S. Federal Protective Service

A current, former or retired judge of an appellate court, a district court,

A police officer or inspector of the U.S. Federal Protective

a statutory probate court, a constitutional county court or a county court

Service.

at law of this state; a current, former or retired associate judge appointed

under Family Code Chapter 201 or Government Code Chapter 54A; a jus-

tice of the peace; a master, magistrate, referee, hearing officer or associate

judge appointed under Government Code Chapter 54; or a municipal court

judge; the judge’s spouse or a current or former employee of the judge.

SECTION 3: Required Documentation



A victim of family violence, sexual assault, abuse, stalking or trafficking should attach to this request a copy of a protective order, a magistrate’s order

for emergency protection or other independent documentary evidence.



A member of the address confidentiality program should attach to this request proof of certification under Code of Criminal Procedure Article 56.84.

SECTION 4: Property Types Associated with Home Address

Select the property type(s) below that may reference or be associated with the qualified applicant’s home address.



Single-family residential

Multi-family residential

Vacant land

Commercial real and personal



Oil, gas and minerals

Other

SECTION 5: Signature

I certify the information in this document and any information attached is true and correct.

_____________________________________________________________

Printed Name of Person Requesting Confidentiality

_____________________________________________________________

____________________________

Signature of Person Requesting Confidentiality

Date

If you make a false statement on this form, you could be found guilty of a Class A misdemeanor or a state jail felony under Penal Code Section 37 .10.

comptroller.texas.gov/taxes/property-tax

Page 2

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50-284 • 09-17/12