Texas Department of Public Safety Request for an Application to Carry a Concealed Handgun or to Be Certified as a Qualified Handgun Instructor PLEASE PRINT OR TYPE.  ALL INFORMATION MUST BE PROVIDED.
Check all that apply:     [  ]   License Application         [  ]   Instructor Certification
Name: Last, First, Middle ____ ______ _____			Date of Birth: month/day/year     /             /
Driver License/State ID Number: [  ]   DL     TX ______ ____________ [  ]   ID      TX _________________ _	Sex:     [  ]   Male     [  ]   Female	Height:     ft.     in.	Weight:                                      lbs.
Race: [  ]   American Indian or Alaskan Native                            [  ]   Black                                           [  ]   Multi-Racial [  ]   Asian or Pacific Islander                                            [  ]   White                                           [  ]   Other
Mailing Address:                                 ______________ ______ ______________________________                                 ______________ ______ ______________________________ City:                        ________________________________________ State:                      _________              Zip: ___________ - ___________ County: ____ Phone: Home:  ( ) _____ - __ ____     Business:  ( ) _____ - __ ____ CR-80 (7/17/95)
MAIL TO:Texas Department of Public Safety CRS/Concealed Handgun Licensing Unit P.O. Box 15888 Austin, Texas 78761-5888

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