Fillable CauseNo. ExParteDistrictCountyJustice Printyourname CourtOf BrazosCounty,Texas PetitionforOccupationalDriversLicense (Brazos County, Texas)

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CauseNo. ExParteDistrictCountyJustice Printyourname CourtOf BrazosCounty,Texas PetitionforOccupationalDriversLicense (Brazos County, Texas)

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BrazosCountyPetitionforOccupationalLicense.Revised7.5.17 Page1
CauseNo.
Theclerkfillsinabove
ExParte§☐District☐County☐Justice
§
Printyourname§ CourtOf
§
§BrazosCounty,Texas
First Middle Last
PetitionforOccupationalDriver’sLicense
Printorfill‐inyouranswers
Mynameis:.
FirstMiddleLast
IamthePetitionerandIamaskingthecourtforanOccupationalDriver’sLicense.
IasktheCourttoconsidertheinformationIhaveprovidedbelow.
UponapprovalofthisPetition,IasktheClerktosendacertifiedcopyofthePetitionandthecourtOrder
settingoutthejudge’sfindingsandrestrictionstotheTexasDepartmentofPublicSafety.
I.Petitioner’sPersonalInformation
1.Homeaddress:
StreetaddressCity
,Texas
CountyZip
2. Mailingaddress(ifdifferentfromabove):
3.Phonenumber:()4.Dateofbirth:
5.Emailaddress:
6. ThelastfourdigitsofmySocialSecurityNumberare or☐IdonothaveaSocialSecurity
Number.

BrazosCountyPetitionforOccupationalLicense.Revised7.5.17 Page2
II.Driver’sLicenseInformation
7. Checkallthatapplyandproviderequestedinformation:
☐IhaveneverheldaTexasDriver’sLicense.
☐MyTexasDriver’sLicensenumberis:ExpirationDate://
☐MyDriver’sLicensewasissuedbytheStateof
MyDriver’sLicensenumberis ExpirationDate: / /
8. Isyourlicensesuspendedbecauseofaphysicalormentaldisability? ☐Yes ☐No
Isyourlicensesuspendedfornon‐paymentofchildsupport? ☐Yes ☐No
Haveyouhad2ormoreoccupationaldriver’slicensesbecauseofaconvictioninthelast10years?
☐Yes ☐No
III.NoticetotheStateifApplicable
9. Ifanyofthefollowingareapplicable,theClerkofthecourtshouldservetheStatewithnoticeofthisPetitionas
requiredbytheTexasTransportationCodesection521.243(a).
(Checkallthatapplyandfillintheblanks)
A. MylicenseissuspendedunderTransportationCodesection521.342.(Convictionofvariousoffensesof
anindividualundertheageof21) ☐Yes ☐No

DateofconvictionCourtofconviction
B. MylicenseissuspendedbecauseIwasconvictedof:
☐CriminallyNegligentHomicide
Penalcode19.05
☐DrivingWhileIntoxicated
Penalcode49.04

☐DWIw/BAC.15orabove ☐DWI‐2
nd
☐DWI‐3
rd
ormore
☐ DrivingWhileIntoxicatedwithChildPassenger
Penalcode49.045
☐FlyingWhileIntoxicated
Penalcode49.05
☐BoatingWhileIntoxicated
Penalcode49.06
☐ AssemblingorOperatinganAmusementRideWhileIntoxicated PenalCode49.065
☐IntoxicationAssaultPenalCode49.07
☐IntoxicationManslaughterPenalCode49.08

onin
Dateofconviction Courtofconviction Countyofconviction
BrazosCountyPetitionforOccupationalLicense.Revised7.5.17 Page3
IV.SuspensionsandCharges
10. WhyisyourDriver’sLicensesuspended?(Checkallthatapplyandfillintheblanks)
A. ☐Iwasarrestedon / / andthebreath/bloodsampleIprovidedregistered
above.08. (date)


B. ☐Iwasarrestedon / / ,andIdidnotgiveabreath/bloodsample,as
requested. (date)

Withinthepastten(10)yearsfromthedateofthearrestthatledtoyourcurrentsuspension,haveyou
hadasuspensionforrefusaltogiveabreath/bloodsampleorprovidingasamplewithbloodalcohol
contentgreaterthan.08followinganarrestforDWI? ☐Yes ☐No

C.☐Iwasconvictedforanoffenseundersection49.04‐49.08andthebloodsampleregistered
intoxicationbyintroductionofdrugs.
D.☐Thiscourtconvictedmeoftheoffenseofon
  / / (date).
E.☐ATexascourtdeterminedthatIama“habitualviolatorofthetrafficlaws.”
F. ☐ATexascourtorderedmetogotoaDriverEducationProgram,andmylicense,permitand/ordriving
privilegeisautomaticallysuspendedfor365days.
G. ☐Other(ifyoudidnotcheckanyoftheabove,whyisyourlicensesuspendedorinvalid?
(Bespecific)


11. Ihavethefollowingcriminalchargespending(YoudonotneedtolistatrafficorClassCcharge).



V.Petitioner’sEssentialNeedtoDrive
Pleasecompletethissectionevenifyourlicenseissuspendedbasedonanalcohol‐relatedoffenseunderPenalCode
49.04‐49.08ANDyouarerequiredtohaveaninterlockdeviceinstalledoneachmotorvehicleyouownoroperate.
12. WhydoyouneedanOccupationalDriver’sLicense?(Checkallthatapply):
☐NameofEmployer#1:
Employer’sAddress:
Daysandhoursyouwork:
Jobtitle:
Areyourequiredtodriveanemployer’svehicleinthecourseofthisemployment?
☐Yes ☐NoIfyes,hasemployerbeennotifiedofsuspension?
BrazosCountyPetitionforOccupationalLicense.Revised7.5.17 Page4
☐NameofEmployer#2:
Employer’sAddress:
Daysandhoursyouwork:
Jobtitle:
Areyourequiredtodriveanemployer’svehicleinthecourseofthisemployment?
☐Yes ☐NoIfyes,hasemployerbeennotifiedofsuspension?
☐ Ineedtodrivetoschool.(Filloutbelow):
SchoolName:
SchoolAddress:
Daysandhoursofyourclasses:(Youmayattachschedule)


☐Other(explain):


13. Drivingscheduleyouarerequesting:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
From: ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm
To: ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm
From: ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm
To: ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm
From: ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm
To: ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm
From: ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm
To: ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm ____am/pm

14. IfyouareaskingtheCourttoallowyoutodriveformorethan4hoursperday,explainwhybelow:



15. IasktheCourttoordertheTexasDepartmentofPublicSafetytoissuemeanOccupationalDriver’sLicenseto
driveforthepurposesdescribedabove.
IfurtheraskthisCourttoordertheTexasDepartmentofPublicSafetytoadministeranyandalltestsrequired
fortheissuanceofsaidOccupationalLicense.

Petitioner’sname(print)

Petitioner’ssignatureDate
BrazosCountyPetitionforOccupationalLicense.Revised7.5.17 Page5
UnswornDeclarationMadeUnderPenaltyofPerjury
AsallowedbySection132.001oftheTexasCivilPracticesandRemediesCode,IamfilingthisUnswornDeclarationin
SupportofthePetitionforOccupationalDriver’sLicenseinplaceofaVerifiedPetition.*
Mycurrentlegalnameis:
FirstMiddleLast
Mydateofbirthis: / /
Month Day Year
Myaddressis:
StreetAddressCityStateZipCodeCountry
IdeclareunderpenaltyofperjurythatallinformationinthisPetitionistrueandcorrect.IunderstandIcouldbe
prosecutedforlyingonthisform.
FormallysignedinCounty,onthis
CountyState
Onthisthedayof,.
DayMonthYear

SignatureofPersonAskingforOccupationalDriver’sLicense
*PursuanttoTexasCivilPracticesandRemediesCodeSection132.001,anunsworndeclarationmaybeusedinlieuofa
writtensworndeclaration,verification,certification,oathoraffidavitrequiredbystatuteorrequiredbyrule,orderor
requirementadoptedasprovidedbylaw.Thisprovisiondoesnotapplytoanoathofofficeoranoathrequiredtobe
takenbeforeaspecifiedofficialotherthananotarypublic.Anunsworndeclarationmadeunderthissectionmustbe1)
inwriting,2)signedbythepersonmakingthedeclarationastrueunderpenaltyofperjuryand3)insubstantiallythe
formusedabove.
SeebelowforalistofdocumentstoattachtothisPetition:
☐ Acertifiedabstract(TypeAR)ofyourdriver’slicenserecord.
☐ AnSR22fromyourinsurancecompanyprovidingproofofcurrentvalidautoliabilityinsurance.
☐ Proofofneedtodrive:Examplesofproof:Aletterfromyouremployerorimmediatesupervisoronyour
employer’sletterheadthatverifiesyourworkschedule,schoolregistrationwithschedule,oryourswornaffidavit
explainingtothecourtwhyyouneedtodriveunlessyourlicenseissuspendedsolelybasedonanintoxicationoffense
underPenalCode49.04‐49.08andanyvehicleyouownoroperatemustbeequippedwithaninterlockdevicewith
camerathatprovidesaclearlyvisibleimageoftheindividualusingtheinterlock.
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CauseNo. ExParteDistrictCountyJustice Printyourname CourtOf BrazosCounty,Texas PetitionforOccupationalDriversLicense (Brazos County, Texas)

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Completed 30 January 2022

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