An official State of Texas website.
Here's how you know.
The .gov means it’s official.
State and federal government websites often end in .gov. Before sharing sensitive information, make sure you’re on an official government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Some forms cannot be viewed in a web browser and must be opened in Adobe Acrobat Reader on your desktop system. Click here for instructions on opening this form.
Effective Date: 1/2015
English PDF: 0066.pdf
Spanish PDF: 0066-S.pdf