Occupational License Case Information Sheet (Criminal)

121903 Filing Information Sheet CAUSE NO. ________________ THE STATE OF TEXAS § § VS . § ________________________________________, § DEFENDANT § IN THE COUNTY CRIMINAL COURT AT LAW NO .______ OF HARRIS COUNTY, TEXAS OCCUPATIONAL LICENSE CASE INFORMATION SHEET You must complete this form and a file copy with every original petition. You must also attach a copy of this form to every original petition served. This information does not constitute a discovery request, response, or supplementation, and is not admissible at trial. On the date of the offense, Petitioner was under 21 years of age . On the date of the offense, Petitioner was over 21 years of age. Administrative License Suspension for : failing the breath or blood test refusing to give a specimen of breath or blood. Automatic Suspension after conviction or being placed on community supervision for: Criminally Negligent Homicide Fraudulent Government Records -- Prosecuted Under TEX. Drug Offense PENAL CODE § 37.10 DWI (Alcohol) False/Fictitious Driver’s License DWI (Drug) or DPS I.D. Card Driving While Commercial Criminal Mischief / Graffiti License Disqualified Intoxication Assault With A DWLI Motor Vehicle Evading Arrest Intoxication Manslaughter Failure To Stop And Render Aid Racing False/Fictitious Motor Vehicle Other ___________________ License Plate, Registration ___________________________ Insignia, Or Safety Inspection Certificates The case was heard in County Crim. Court at Law No. ___. The case was heard in _____District Court The offense occurred in __________________ County. The license was suspended on ___________________. Name of individual filing cover sheet: Attorney or pro se (signature) Printed name Bar card (if applicable) Telephone number Address American LegalNet, Inc. www.USCourtForms.com 121903 Filing Information Sheet Statutory References for Automatic Suspensions Automatic Suspensions Criminally Negligent Homicide [TEX. TRANSP. CODE § 521.341] Drug Offense [TEX. TRANSP. CODE § 521.372] DWI (Alcohol) [TEX. TRANSP. C ODE § 521.344] DWI (Drug) [TEX. TRANSP. CODE § 521.372] Driving While Commercial License Disqualified [TEX. TRANSP. CODE §§ 522.071; 521.457; 521.292(a)(1); 521.293] DWLI [TEX. TRANSP. CODE §§ 521.457; 521.292; 521.293] Evading Arrest [TEX. TRANSP. CODE §§ 521.341(2)] Failure To Stop And Render Aid [TEX. TRANSP. C ODE §§ 521.341(6)] False/Fictitious Motor Vehicle License Plate, Registration Insignia, Or Safety Inspection Certificates [TEX. TRANSP. CODE § 521.3465] Fraudulent Government Records -- Prosecuted Under TEX. P ENAL CODE § 37.10 [TEX. TRANSP. C ODE §§ 521.3466, 521.312] False/Fictitious Driver’s License or DPS I.D. Card [TEX. TRANSP. CODE §§ 521.341(7), 521.451] Criminal Mischief / Graffiti [TEX. TRANSP. CODE § 521.320] Intoxication Assault With A Motor Vehicle [TEX. TRANSP. C ODE § 521.341] Intoxication Manslaughter [TEX. TRANSP. CODE § 521.341] Racing [TEX. TRANSP. CODE § 521.350] American LegalNet, Inc. www.USCourtForms.com