Application For Driver Permit - Fort Worth Page 2
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1
2Attach the following:
1.
Written proof of completing a defensive driving course within past 12 months
2.
An explanation of any and all convictions of federal, state and municipal law
3.
A copy of the Drug and Alcohol Screening and Release Form
4.
Texas Driver’s License
5.
Proof of legal residence
6.
Social Security Card
7.
An application fee of $35.00 Money Order
Complete if Applicable:
Accidents
Date
Location
Were you at fault?
_____/_____/_____
_________________________________________________
( ) Yes
( ) No
_____/_____/_____
_________________________________________________
( ) Yes
( ) No
Traffic Convictions (Moving Only)
Date
Violations
_____/____/_____
_________________________________________________
_____/____/_____
_________________________________________________
_____/____/_____
_________________________________________________
Certification:
I certify that all answers and information I have given on this form or on the attachments to this
form are accurate and complete. Any false or misleading information entered on this application may be cause for
denial or revocation of the requested permit.
Applicant’s Signature___________________________________________________Date_____________________
*******************************************************************************************
Notarized:
I (the company owner or representative authorized to sign City of Fort Worth Driver Permit
Applications), do hereby certify that the driver listed on this application will be driving for ___________________________
_______________________________________________________________________________________.
Authorized by:_____________________________________________________________________________Date_____________________________
Company Authorized Driver Permit Application signature only
THE STATE OF TEXAS, COUNTY OF _________________________________________
I, ________________________________________________, do hereby certify that on the _________day of _____________, 20_____,
personally appeared before me ___________________________________ (Company Authorized Signature only), declared that
he or she is the person who signed the foregoing document and the statements therein contained are true.
SEAL
______________________________________________
Notary public in and for the State of Texas
My commission expires:___________________
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