Form LTC-79 "Affidavit for Former Reserve Law Enforcement Officer" - Texas

What Is Form LTC-79?

This is a legal form that was released by the Texas Department of Public Safety - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2019;
  • The latest edition provided by the Texas Department of Public Safety;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form LTC-79 by clicking the link below or browse more documents and templates provided by the Texas Department of Public Safety.

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Download Form LTC-79 "Affidavit for Former Reserve Law Enforcement Officer" - Texas

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AFFIDAVIT FOR FORMER RESERVE LAW ENFORCEMENT OFFICER
STATE OF
§
§
(STATE WHERE NOTARIZED)
§
COUNTY OF
§
(COUNTY WHERE NOTARIZED)
BEFORE ME, the undersigned Notary Public, on this day personally appeared, and stated under oath:
“My name is
and I am the
of the
(Head of Law Enforcement Agency)
(Title)
. I am over eighteen years of age, of sound mind, and capable of making this affidavit.
(Name of Agency)
hereinafter referred to as Applicant, at the time of retirement,
Applicant Name)
held the rank of______________; and held the status of Reserved Law Enforcement Officer for not less than a total of
(Title)
10 years with one or more state or local law enforcement agencies.
Provide a list of the type of weapons the applicant demonstrated proficiency with during the applicants term of service:
____________________, ____________________, ____________________, ____________________.
(Type of Weapon)
(Type of Weapon)
(Type of Weapon)
(Type of Weapon)
Was the Applicant accused of misconduct at any time during their term of service? ___ Yes ___ No
If yes, provide a brief statement of the misconduct and disposition of that accusation or provide an attached addendum.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Please describe the physical and mental condition of the applicant: ___________________________________________
Would the Applicant be eligible for reemployment with the Agency? ___Yes ___No
Is the Applicant recommended for issuance of a License to Carry a Handgun? ___Yes ___No
HEAD OF LAW ENFORCEMENT AGENCY Signature
SUBSCRIBED and SWORN TO before me on this
day of
, 20
.
(DAY)
(MONTH)
(YEAR)
NOTARY PUBLIC Signature
[seal]
PRINTED NAME OF NOTARY PUBLIC (if not on seal)
My commission expires:
LTC-79 (Rev. 11/19)
AFFIDAVIT FOR FORMER RESERVE LAW ENFORCEMENT OFFICER
STATE OF
§
§
(STATE WHERE NOTARIZED)
§
COUNTY OF
§
(COUNTY WHERE NOTARIZED)
BEFORE ME, the undersigned Notary Public, on this day personally appeared, and stated under oath:
“My name is
and I am the
of the
(Head of Law Enforcement Agency)
(Title)
. I am over eighteen years of age, of sound mind, and capable of making this affidavit.
(Name of Agency)
hereinafter referred to as Applicant, at the time of retirement,
Applicant Name)
held the rank of______________; and held the status of Reserved Law Enforcement Officer for not less than a total of
(Title)
10 years with one or more state or local law enforcement agencies.
Provide a list of the type of weapons the applicant demonstrated proficiency with during the applicants term of service:
____________________, ____________________, ____________________, ____________________.
(Type of Weapon)
(Type of Weapon)
(Type of Weapon)
(Type of Weapon)
Was the Applicant accused of misconduct at any time during their term of service? ___ Yes ___ No
If yes, provide a brief statement of the misconduct and disposition of that accusation or provide an attached addendum.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Please describe the physical and mental condition of the applicant: ___________________________________________
Would the Applicant be eligible for reemployment with the Agency? ___Yes ___No
Is the Applicant recommended for issuance of a License to Carry a Handgun? ___Yes ___No
HEAD OF LAW ENFORCEMENT AGENCY Signature
SUBSCRIBED and SWORN TO before me on this
day of
, 20
.
(DAY)
(MONTH)
(YEAR)
NOTARY PUBLIC Signature
[seal]
PRINTED NAME OF NOTARY PUBLIC (if not on seal)
My commission expires:
LTC-79 (Rev. 11/19)