Form LTC-82 Sworn Statement of Employment for Purposes of Texas Government Code 411.179(C) - Texas

Form LTC-82 or the "Sworn Statement Of Employment For Purposes Of Texas Government Code 411.179(c)" is a form issued by the Texas Department of Public Safety.

Download a PDF version of the Form LTC-82 down below or find it on the Texas Department of Public Safety Forms website.

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SWORN STATEMENT OF EMPLOYMENT
FOR PURPOSES OF
TEXAS GOVERNMENT CODE §411.179(C)
STATE OF
§
§
(STATE WHERE NOTARIZED)
§
COUNTY OF
§
(COUNTY WHERE NOTARIZED)
BEFORE ME, the undersigned authority, personally appeared
, who made
this Affidavit and, on oath, stated the following:
(PRINTED NAME OF APPLICANT)
I
hereby swear and affirm that the following information is true and correct:
(PRINTED NAME OF APPLICANT)
I am an active judge or attorney, not retired, and am currently employed as a:
(
) Attorney General
(
) District Attorney
(
) Assistant Attorney General
(
) Assistant District Attorney
(
) United States Attorney
(
) Prosecuting Attorney
(
) Assistant United States Attorney
(
) Assistant Prosecuting Attorney
(
) County Attorney
(
) Criminal District Attorney
(
) Assistant County Attorney
(
) Assistant Criminal District Attorney
(
) Judge
(
) Justice
Applicant’s Signature
SUBSCRIBED and SWORN TO before me, this
day of
, 20
.
(DAY)
(MONTH)
(YEAR)
NOTARY PUBLIC Signature
[seal]
Printed Name of NOTARY PUBLIC (if not on seal)
LTC-82 (Rev. 9/17)
SWORN STATEMENT OF EMPLOYMENT
FOR PURPOSES OF
TEXAS GOVERNMENT CODE §411.179(C)
STATE OF
§
§
(STATE WHERE NOTARIZED)
§
COUNTY OF
§
(COUNTY WHERE NOTARIZED)
BEFORE ME, the undersigned authority, personally appeared
, who made
this Affidavit and, on oath, stated the following:
(PRINTED NAME OF APPLICANT)
I
hereby swear and affirm that the following information is true and correct:
(PRINTED NAME OF APPLICANT)
I am an active judge or attorney, not retired, and am currently employed as a:
(
) Attorney General
(
) District Attorney
(
) Assistant Attorney General
(
) Assistant District Attorney
(
) United States Attorney
(
) Prosecuting Attorney
(
) Assistant United States Attorney
(
) Assistant Prosecuting Attorney
(
) County Attorney
(
) Criminal District Attorney
(
) Assistant County Attorney
(
) Assistant Criminal District Attorney
(
) Judge
(
) Justice
Applicant’s Signature
SUBSCRIBED and SWORN TO before me, this
day of
, 20
.
(DAY)
(MONTH)
(YEAR)
NOTARY PUBLIC Signature
[seal]
Printed Name of NOTARY PUBLIC (if not on seal)
LTC-82 (Rev. 9/17)

Download Form LTC-82 Sworn Statement of Employment for Purposes of Texas Government Code 411.179(C) - Texas

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