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Disclaimer: This document includes both a guide to the process and free forms (petition, etc.

) that can be
used in a do-it-yourself way to get your criminal record expunged or sealed. Hopefully, reading through it from
start to finish will help you to understand how this process works in Texas and you will be able to get your
criminal record removed from public view. These forms and this guide are provided as a public service by their
copyright owner, Michael Lowe, who is a Board Certified Criminal Defense law practicing in Dallas, Texas.
However, you are not forming any kind of attorney-client relationship with him here. It is hoped that you can
understand and fill these forms out without the need for a lawyer. If you have a few simple questions, then you
may be able to get answers at no cost to you by calling the clerk of the court where you were convicted.
ELIGIBILITY FOR REQUIREMENTS TO EXPUNGE
YOUR CRIMINAL RECORD IN TEXAS
To determine whether you are eligible to have your criminal record(s) expunged in Texas, please
answer the following questions:
I. DISMISSAL, NOT PRESENTED, NO BILL BY GRAND JURY
1. Were you arrested or charged with a crime and your case was dismissed by the court
and you were never placed on any kind of probation for this case?
2. Were you arrested or charged with a felony and the case was presented to the Grand
Jury and No Billed (Grand Jury did not indict) by the Grand Jury?
3. Were you arrested for a felony or misdemeanor and your case was never filed with
any District Attorney’s office?
4. Were you arrested and charged with a felony and your case was never presented to the
Grand Jury for indictment?
If you answered yes to any of the above questions and you have not been previously convicted of a
felony in the five (5) years before you were arrested for or charged with the offense for which you
seek an expunction, you are eligible if the applicable waiting period has expired before you file your
petition to expunge your record. To determine what the waiting period is for your particular arrest or
charge, please see the following chart below.
If you did not answer yes to any of the above, go to parts II, III, IV and V.
I. DISMISSAL, NOT PRESENTED, NO BILL BY GRAND JURY:
STATUTE OF LIMITATIONS CHART
MISDEMEANOR CASES
1. Class “C” Misdemeanor waiting period is 180 days from date of arrest.
2. Class “B” Misdemeanor waiting period is one year from date of arrest.
3. Class “A” Misdemeanor waiting period is one year from date of arrest.
FELONY CASES
For felony arrests or charges, the applicable waiting period is three (3) years from the date of arrest.
If the applicable waiting period has not yet expired, the attorney representing the State of Texas (e.g.
county attorney, district attorney, or city attorney) must first certify that records related to the arrest
are not needed in any criminal investigation or charge before you can be eligible to expunge your
record.
II. NOT GUILTY BY JUDGE OR JURY
Did a judge or jury find you not guilty?
If yes, then you can have your record expunged.
III. PARDONED BY THE TEXAS GOVERNOR’S OFFICE
After you were convicted of an offense, did the State of Texas Governor grant a full pardon to you
for the offense?
If yes, then you can have your record expunged.
IV. DEFERRED ADJUDICATION ON CLASS “C” MISDEMEANORS
Did you receive a deferred adjudication for a Class “C” Misdemeanor offense?
Was the Class “C” Misdemeanor a traffic ticket to a person younger than 17, an offense committed
by a person who holds a commercial drivers license or was a traffic offense committed in a
construction zone?
If you answered yes to the first question and no the second, then you are eligible for an expunction
after two years from date of offense.
If you answered yes to both questions, your case is not eligible to be expunged.
If you answered no to the first question, your case is not eligible to be expunged.
What is deferred adjudication?
Deferred adjudication is a non-conviction type of probation. If you successfully complete your
probation, there is no conviction and your case is dismissed. If you are not sure whether you had a
deferred adjudication probation or a regular (conviction type) probation, contact the court and ask for
a copy of the judgment and sentence for your case. The judgment or sentence will state what type of
probation you received.
What is a Class “C” Misdemeanor?
A class “C” misdemeanor is punishable only be a fine. It is the lowest level of misdemeanor. For
example, theft less than $50 or contact/threat assault are class “C” misdemeanors. Most commonly,
class “C” misdemeanors are filed in municipal courts or Justice of the Peace courts. However, if
your case was originally filed in a county or district court, it could have been reduced to a class “C”
misdemeanor. If you don’t know, you can contact the court to get a copy of the judgment and
sentence for your case.
V. IF YOU DO NOT FIT INTO ANY OF THE CATEGORIES LISTED ABOVE,
YOUR CASE CANNOT BE EXPUNGED.
INSTRUCTIONS FOR PETITIONS TO EXPUNGE RECORDS
1. Fill out your Petition. All “grey” text field regions must be filled out! After completing all text
fields sign your Petition and have it notarized.
2. Locate the address to the District Clerk’s Office of where you case originally arose. Go to
http://texasclerks.com/ to find the correct District Clerk’s address information.
3. Contact the District Clerk’s Office to find out what the filing fee is in that particular county. (You
must do this, because the filing fees vary greatly from county to county.) Go to http://texasclerks.com/ to
find the correct District Clerk’s phone number.
4. File or mail Petition To Expunge and the Cover Letter and enclose a check for the appropriate
filing fee amount due to the District Clerk’s Office. Make sure you include the correct number of copies
and a self-addressed stamped envelope so the court can return a file-stamped copy of your Petition.
5. When you receive the file stamped copy back, check the Fiat to find out what date the Court has
set your Petition For Expunction for a hearing.
6. Once you have a hearing date set, contact District Attorney’s office. (The District Clerk will give
you their phone number.) Find the prosecutor who handles Expunctions and ask them whether they will
agree to expunge the record.
7. If the prosecutor agrees to expunge, then request that the prosecutor notify the court in writing that
there is an agreement to expunge.
8. Have the prosecutor sign the proposed order to expunge your criminal record.
9. If the prosecutor agrees to expunge and signs the proposed order, submit the order for the judge=s
approval and signature. Usually the prosecutor will do this for you.
10. If the prosecutor will not agree to expunge, you must attend the hearing on the date set by the
court.
11. During the hearing make sure that everything is recorded by the court reporter. REQUEST A
CONTINUANCE IF THERE IS NO COURT REPORTER. Make sure you state on the record all of the
reasons that you are eligible to have your record expunged. If you are not sure, bring a copy of the petition
you filed and read into the court=s record all of the reasons you feel that you qualify to have your record
expunged.
TODAY'S DATE
NAME OF CLERK
ADDRESS OF CLERK
CITY, STATE ZIP
Re: Petition for Expunction of Records - NAME OF PETITIONER
Dear Clerk:
Enclosed please find an original and five copies of the above-mentioned petition, along with
an order, for your convenience, setting a hearing date and a check in the amount of $ AMOUNT OF
MONEY. Please file stamp one of the copies and return it to me, along with the order once a hearing
date has been set, in the enclosed self-addressed stamped envelope.
If you have any questions regarding this, please do not hesitate to contact me. Thank you for
your assistance in this matter.
Sincerely,
NAME OF PETITIONER
Enclosures
PETITION FOR EXPUNCTION OF RECORDS PAGE 7
CAUSE NO. _________________
EX PARTE ' IN THE _______________________
'
VS. ' JUDICIAL DISTRICT COURT
'
NAME AT TIME OF OFFENSE '
' _________________COUNTY, TEXAS
COUNTY WHERE CASE WAS FILED
PETITION FOR EXPUNCTION OF RECORDS
TO THE HONORABLE JUDGE OF SAID COURT:
YOUR NAME AT TIME OF THE OFFENSE, Petitioner, petitions the Court to order the
expunction of all records and files arising out of Petitioner’s arrest on DATE OF ARREST, and in
support of this petitioner shows:
I.
Petitioner is a RACE SEXwhose full name is YOUR NAME AT TIME OF THE OFFENSE.
Petitioner was born on DATE OF BIRTH. Petitioner’s Texas Driver’s License No. is YOUR
LICENSE NUMBER IF YOU HAVE ONE, and his/her Social Security No. is YOUR SOCIAL
SECURITY NUMBER IF YOU HAVE ONE.
II.
PETITION FOR EXPUNCTION OF RECORDS PAGE 8
On DATE OF ARREST IF NEVER ARRESTED, LIST DATE CASE WAS FILED,
Petitioner was arrested in the City of CITY OF ARREST by a NAME OF POLICE AGENCY, ex.:
Dallas Police, Officer, charging him/her with OFFENSE CHARGED.
[IF CASE WAS NO BILLED BY THE GRAND JURY, DO THE FOLLOWING:]
Under Cause Number _________________, said case was presented to a Grand Jury and no
billed by a COUNTY CASE WAS FILED IN, ex: DALLAS County Grand Jury on DATE CASE
WAS NO BILLED.
[IF CASE WAS NOT FILED BEFORE THE WAITING PERIOD, DO THE
FOLLOWING:]
Since the aforementioned date of arrest and until the filing of this Petition, no case arising out
of this arrest has been filed with any District Attorney Office or presented to any Grand Jury. Before
the filing of this petition, the applicable waiting period had expired.
[IF CASE WAS DISMISSED AND THE APPLICABLE WAITING PERIOD
HAS EXPIRED, DO THE FOLLOWING:]
Cause Number _________________was dismissed DATE OF DISMISSAL. Since
that time the applicable waiting period LIST APPLICABLE LIMITATIONS PERIOD has expired
and no other case has been filed prior to the expiration of said limitations period.
[IF CASE WAS DISMISSED FOR LACK OF PROBABLE CAUSE AND THE
PETITION FOR EXPUNCTION OF RECORDS PAGE 9
APPLICABLE WAITING PERIOD HAS NOT EXPIRED, DO THE FOLLOWING:]
Cause Number _________________, was dismissed for lack of probably cause, DATE OF
DISMISSAL , LIST ALL REASONS THAT YOU BELIEVE THAT THERE WAS NO
PROBABLY CAUSE
[IF CASE WAS TRIED AND DEFENDANT WAS FOUND NOT GUILTY, DO THE
FOLLOWING:]
In Cause Number _________________, and on DATE OF VERDICT, a COUNTY OF
TRIAL County JURY or JUDGE found Defendant NAME OF PETITIONER not guilty.
[IF DEFERRED ADJUDICATION ON CLASS “C” MISDEMEANOR, DO THE
FOLLOWING:]
On DATE PLACE ON DEFERRED ADJUDICATION PROBATION, Petitioner was placed
on a deferred adjudication probation in NAME OF COURT, ex: Dallas Municipal Court for TYPE
OF OFFENSE , a class “C” misdemeanor.
III.
Petitioner has reason to believe that the following agencies, officials, or other public entities
of this state have records concerning the arrest:
1) ARRESTING OR CHARGING POLICE AGENCY ex:
Dallas Police Department
Jack Evan Police Headquarters
1400 S. Lamar Street
Dallas, Texas 75215-1815
PETITION FOR EXPUNCTION OF RECORDS PAGE 10
Records Division
2) PROSECUTING ATTORNEY'S OFFICE ex:
Dallas District Attorney=s Office
133 N. Industrial Blvd.
Dallas, Texas 75207
Records Department
3) IF FELONY, DISTRICT CLERK OFFICE; IF MISDEMEANOR, COUNTY CLERK
OFFICE ex:
Dallas District Clerk
133 N. Industrial Blvd.
Dallas, Texas 75207
Records Department
4) Texas Department of Public Safety
5805 N. Lamar
P. O. Box 4087
Austin, Texas 78773
IV.
Pursuant to Articles 45 and 55 of the Texas Code of Criminal Procedure, Petitioner is entitled
to have all records and files concerning the arrest expunged for one or more of the following reasons:
[ONLY SELECT APPLICABLE SITUATION LISTED BELOW]:
5.1 No indictment or information has been presented against Petitioner for an offense
arising out of the transaction before the applicable waiting period. And:
• No charges against Petitioner arising out of the transaction for which
Petitioner was arrested have resulted in a final conviction or are pending.
PETITION FOR EXPUNCTION OF RECORDS PAGE 11
• There was no court-ordered probation under Article 42.12 of the Code of
Criminal Procedure on this matter.
• Petitioner was not released on a conditional discharge under Section 4.12 of
the Texas Controlled Substance Act.
• Petitioner had not been convicted of a felony in the five years preceding
Petitioner’s arrest or charge that makes the subject of this petition.
5.2 This case was No Billed by a Grand Jury and the applicable waiting period has
expired before the filing of this case and no other case arising out of this transaction
was ever presented to a Grand Jury. And:
• No charges against Petitioner arising out of the transaction for which
Petitioner was arrested have resulted in a final conviction or are pending.
• There was no court-ordered probation under Article 42.12 of the Code of
Criminal Procedure on this matter.
• Petitioner was not released on a conditional discharge under Section 4.12 of
the Texas Controlled Substances Act.
• Petitioner had not been convicted of a felony in the five years proceeding
Petitioner’s arrest or charge that makes the subject of this petition.
5.3 Petitioner was found not guilty by a judge or jury, and that was the final disposition
PETITION FOR EXPUNCTION OF RECORDS PAGE 12
on the charge that makes the subject of this petition.
5.4 The Governor for the State of Texas granted Petitioner a full pardon for the offense
that makes the subject of this petition.
5.5 Petitioner was placed on a deferred adjudication probation for a class
misdemeanor and later successfully completed said probation and said case was
dismissed.
5.6 This case was Dismissed and the applicable waiting period has expired before the
filing of this case and no other case arising out of this transaction was filed. And:
• No charges against Petitioner arising out of the transaction for which Petitioner was
arrested have resulted in a final conviction or are pending.
• There was no court-ordered probation under Article 42.12 of the Code of Criminal
Procedure on this matter.
• Petitioner was not released on a conditional discharge under Section 4.12 of the
Texas Controlled Substances Act.
• Petitioner had not been convicted of a felony in the five years proceeding Petitioner’s
arrest or charge that makes the subject of this petition.
5.7 This case was dismissed due to a lack of probable cause.
WHEREFORE, the Petitioner prays the Court:
PETITION FOR EXPUNCTION OF RECORDS PAGE 13
1. To set this matter for hearing.
2. To give reasonable notice of hearing to each official, agency, or other public entity
named in Paragraph III of this Petition pursuant to Article 55.02, Section 2 of the
Texas Code of Criminal Procedure.
3. After the hearing on this matter, to order each official, agency, or other public entity
that there is reason to believe possesses records or files concerning the arrest to:
a. Return all records and files concerning the arrest to the Court, or if removal is
impracticable, obliterate all references to Petitioner to return al such records
and files to the Court, or if removal is impracticable, to obliterate all
references to Petitioner and notify the Court of its action.
b. Request each central federal depository to which it supplied information
concerning the arrest of Petitioner to return all such records and files to the
Court, or if removal is impracticable, to obliterate all references to Petitioner
and notify the Court of its action.
c. Delete from its public records all index references to the above mentioned
arrest of the Petitioner.
4. To direct the clerk of the Court to send a certified copy of the Order by certified mail,
return receipt requested, to the Department of Public Safety and to each official,
agency, or other entity named in Paragraph III of the Petition; and to direct the
PETITION FOR EXPUNCTION OF RECORDS PAGE 14
Department of Public Safety to send to each central federal depository an explanation
of the effect of the Order as well as a request for the return or destruction of the
records held by the central federal depository.
5. To return to the Petitioner all records, files, and notifications of the disposition of
records and files returned to the Court pursuant to its Expunction Order within a
reasonable time of the receipt of same.
Respectfully submitted,
_________________
NAME OF PETITIONER
ADDRESS OF PETITIONER
PHONE NUMBER OF PETITIONER
FAX NUMBER OF PETITIONER
PETITIONER APPEARING PRO SE
PETITION FOR EXPUNCTION OF RECORDS PAGE 15
AFFIDAVIT
BEFORE ME, the undersigned authority, on this day personally appeared
_______________________________________ , who after being duly sworn stated:
AI am the Petitioner in this cause. I have read the Petition for Expunction of Records and
swear that all of the allegations of fact contained in the Petition are true and correct.@
__________________________________
NAME OF PETITIONER
SUBSCRIBED AND SWORN TO BEFORE ME on this the ______ day of
_________________, 20____.
___________________________________
Notary Public in and for the State of Texas
My Commission Expires: ______________
PETITION FOR EXPUNCTION OF RECORDS PAGE 16
CAUSE NO. _________________
EX PARTE ' IN THE _______________________
'
VS. ' JUDICIAL DISTRICT COURT
'
NAME AT TIME OF OFFENSE '
' _________________COUNTY, TEXAS
COUNTY WHERE CASE WAS FILED
ORDER SETTING HEARING DATE
It is ORDERED that the hearing on the Petition for Expungement of Records is hereby set
for ________ o=clock, ____. m. on the ____ day of _________________, 20___, in the courtroom
of the _______________________________ Court in Dallas, Texas.
SIGNED this the _____ day of ______________________, 20___
_____________________________________
JUDGE PRESIDING
PETITION FOR EXPUNCTION OF RECORDS PAGE 17
CAUSE NO. _________________
EX PARTE ' IN THE _______________________
'
VS. ' JUDICIAL DISTRICT COURT
'
NAME AT TIME OF OFFENSE '
' _________________COUNTY, TEXAS
COUNTY WHERE CASE WAS FILED
ORDER GRANTING EXPUNCTION
I.
Petitioner has the following description: [FILL IN YOUR IDENTIFYING INFORMATION]
Race:
Sex:
Date of Birth:
Texas driver’s license #:
Social Security #:
Address at time of arrest:
II.
The Court finds that the Petitioner is entitled to expunction of the following Dallas County
arrest by the Police Department: [FILL IN OFFENSE IDENTIFYING INFORMATION]
Offense Date Arrest Date Offense Number
III.
PETITION FOR EXPUNCTION OF RECORDS PAGE 18
Respondents are:[ADD ALL POLICE AGENCIES INVOLVED IN YOUR CASE
INCLUDING SHERRIFF IN COUNTY WHERE OFFENSE OCCURRED, COUNTY AND
DISTRICT CLERK’S OFFICES AND DPS. THE FOLLOWING ARE EXAMPLES, THESE
DON’T NECESSARILY APPLY TO YOUR CASE]
3.1 Dallas Police Department
Records Division
2014 Main Street
Dallas, Texas 75201
3.2 Dallas District Attorney’s Office
Records Department
133 N. Industrial Blvd.
Dallas, Texas 75207
3.3 Dallas County District Clerk
Records Department
133 N. Industrial Blvd.
Dallas, Texas 75207
3.4 Dallas County Sheriff’s Department
Records Department
133 N. Industrial Blvd.
Dallas, Texas 75207
3.5 Texas Department of Public Safety
Crime Records Division - MSC 0234
P. O. Box 4143
Austin, Texas 78765-4143
3.6 PETITIONER HAS REASON TO BELIEVE THAT BY INPUT INTO THE
NATIONAL CRIME INDEX COMPUTER, THE FEDERAL BUREAU OF
INVESTIGATION MAY HAVE STORED INFORMATION CONCERNING THE
ARREST FOR WHICH THIS PETITION IS BEING BROUGHT. WHILE THESE
FEDERAL AGENCIES ARE NOT “RESPONDENTS” IN THE STATE
PROCEEDINGS, PURSUANT TO TEXAS CODE OF CRIMINAL PROCEDURE
PETITION FOR EXPUNCTION OF RECORDS PAGE 19
ART. 55.20, SECTION 3(A), THE TEXAS DEPARTMENT OF PUBLIC SAFETY
SHALL FORWARD THE FINAL ORDER EMANATING FROM THE STATE
PROCEEDINGS TO THE FBI.
IV.
The Court finds that Respondents have been served with a copy of the petition as required by
law.
V.
IT IS THEREFORE ORDERED that all records and filed pertaining to the arrest be
expunged. Related arrests (same or similar charge, date, or arresting agency) not specifically listed
herein are excluded from this expunction order. However, records of such unexpunged arrests which
would not have been generated except for the expunged arrest shall be expunged.
VI.
The phrase “all records and files pertaining to the arrest” does include records and files which
were generated by respondents during this expunction proceeding, including the copies of the
petition (and of this order) which are served on each respondent.
VII.
In accordance with TEX. CODE CRIM. PROC. ANN. Art. 55.06, the phrase “all records and
files pertaining tot he arrest” does not include records relating to the suspension or revocation of a
driver’s license, permit or privilege to operate a motor vehicle except as provided in TEX. TRANSP.
CODE ANN. §524.015 and §724.048 (Vernon Pamphlet 1996).
VIII.
8.1 Records and files pertaining to the arrest shall be expunged by turning them in to the
clerk of this court, in a sealed envelope, by hand delivery or by mail to [THE
DISTRICT CLERK’S OFFICE FOR THE COUNTY IN WHICH YOU ARE
FILING THIS PETITION, FOR EXAMPLE]:
PETITION FOR EXPUNCTION OF RECORDS PAGE 20
District Clerk
Attention: Expunction Section
133 N. Riverfront Blvd.
Dallas, Texas 75207
8.2 Videotapes and audiotapes shall be expunged by erasing them.
8.3 Records which pertain both to this arrest and to other arrests which are not included
in this order, and which would have been generated even if the expunged arrest had
not been made, shall be obliterated (covered with tape, liquid paper, or other opaque
substance) only insofar as they pertain to this arrest. A photocopy of such records,
partially obliterated, shall be forwarded to the District Clerk as specified in 8.1.
8.4 Each respondent that has sent information concerning the arrest to a central federal
depository shall request such depository to return all records and files subject to the
order of expunction.
8.5 Each respondent shall attach a certificate to the sealed envelope, certifying that these
are all the expunged records; and, if the respondent has sent information concerning
the arrest to a central federal depository, it shall also certify that the respondent
requested such depository to return all records and files subject to the order of
expunction.
8.6 Alternatively, records pertaining to this arrest may be expunged by the record keeping
agency obliterating or destroying the records. The agency shall then send a certificate
to the District Clerk’s Office certifying that the records have been destroyed.
IX.
No copy of this order shall be given to Petitioner, nor to any Respondent, nor to any other
person, until it has become final and until the clerk has certified to its finality. When it has become
final, the clerk shall so certify and shall mail certified copies of it:
9.1 by certified mail, return receipt requested, to the [COUNTY IN WHICH THIS
PETITION IN FILED] County District Attorney’s Office on behalf of itself and all
county law enforcement agencies;
PETITION FOR EXPUNCTION OF RECORDS PAGE 21
9.2 by ordinary first class mail to Petitioner or his attorney; and
9.3 by certified mail, return receipt requested, to all other Respondents.
No Respondent shall comply with this order until it has been thus served.
X.
If the Petitioner should file a civil action arising out of his arrest which is the subject of this
expunction, he necessarily by his own allegations makes the materials contained in the expunged
records, as well as the contents of the expunction file, a matter of public record subject to discovery
proceedings. W.V. v. State, 669 S.W.2d 376, 379 (Tex. App. – Collin 1984, writ ref’d n.r.e.). If the
expunction file is still in the [COUNTY IN WHICH THIS PETITION IN FILED] County District
Clerk’s custody, the person seeking discovery of its contents shall notify the [COUNTY IN WHICH
THIS PETITION IN FILED] County District Clerk and the [COUNTY IN WHICH THIS PETITION
IN FILED] County District Attorney’s Office. Upon motion and order, the clerk of this court shall
deliver the expunction file to the clerk of the civil court where said action is pending, taking his
receipt for the same.
XI.
The costs which are described in Art. 102.006 of the Code of Criminal Procedure are
assessed against Petitioner.
XII.
The clerk of the court shall destroy all files or other records collected or maintained pursuant
to this expunction on or after the first anniversary of the date the order of expunction was issued,
unless the records or files were released to the Petitioner before that date pursuant to court order.
XIII.
The expunction file shall be released to Petitioner, upon request, no sooner than six months
after the date of this order.
PETITION FOR EXPUNCTION OF RECORDS PAGE 22
XIV.
All relief prayed for not herein specifically granted is hereby denied.
SIGNED this ____ day of ____________________, 20__.
_________________________________
JUDGE PRESIDING
APPROVED AS TO FORM:
_________________________________
ATTORNEY FOR PETITIONER
_________________________________
ASSISTANT DISTRICT ATTORNEY
CERTIFICATE OF FINALITY
I, [NAME OF THE DISTRICT CLERK FOR THE COUNTY WHERE PETITION FILED],
District Clerk of [COUNTY IN WHICH THIS PETITION IN FILED] County, Texas, do certifythat
I have custody of the official records of the district courts of [COUNTY IN WHICH THIS
PETITION IN FILED] County, Texas. A search of the record in this cause reveals that no motion for
new trial, notice of appeal, or motion in arrest of judgment has been filed by any party within 30 days
after signing of the foregoing order (next business day if the 30
th
day is a Saturday, Sunday, or legal
holiday).
PETITION FOR EXPUNCTION OF RECORDS PAGE 23
WITNESS my hand and seal of office this _____ day of ____________________, 20___.
[NAME OF DISTRICT CLERK]
DISTRICT CLERK
[NAME OF COUNTY] COUNTY, TEXAS
By: ____________________________
Deputy