121903 Filing Information SheetCAUSE NO. THE STATE OF TEXAS§IN THE COUNTY CRIMINAL §VS.§COURT AT LAW NO., § DEFENDANT§OF HARRIS COUNTY, TEXASOCCUPATIONAL LICENSE CASE INFORMATION SHEETYou 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 Drug Offense DWI (Alcohol) DWI (Drug) Driving While Commercial License Disqualified DWLIEvading Arrest Failure To Stop And Render Aid False/Fictitious Motor Vehicle License Plate, Registration Insignia, Or Safety Inspection CertificatesFraudulent Government Records --Prosecuted Under TEX. PENAL CODE § 37.10 False/Fictitious Driver's License or DPS I.D. Card Criminal Mischief / Graffiti Intoxication Assault With A Motor Vehicle Intoxication Manslaughter RacingOther 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 nameBar card (if applicable)Telephone numberAddressAmerican LegalNet, Inc. www.USCourtForms.com121903 Filing Information SheetStatutory References for Automatic SuspensionsAutomatic SuspensionsCriminally Negligent Homicide [TEX. TRANSP. CODE § 521.341] Drug Offense [TEX. TRANSP. CODE § 521.372] DWI (Alcohol) [TEX. TRANSP. CODE § 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. CODE §§ 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. PENAL CODE § 37.10 [TEX. TRANSP. CODE §§ 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. CODE § 521.341] Intoxication Manslaughter [TEX. TRANSP. CODE § 521.341] Racing [TEX. TRANSP. CODE § 521.350]American LegalNet, Inc. www.USCourtForms.com