Fillable Printable Lf606 Criminal History

Lf606 Criminal History

Dealer & Licensees Form LF606

(Rev 4/17)

Page 1 of 1

(512) 465-3000

Toll-Free (888) 368-4689

Form available online at www.TxDMV.gov

Criminal History

If you answered “yes” to Questions 1-3 on Ownership Information Form LF601 or Representative Information Form LF603, you must

submit this form. For each offense, provide specific details on a separate copy of this Criminal History form, and attach relevant court

documents. It is your responsibility to provide any recommendations from the prosecution, law enforcement, or correctional authorities,

in accordance with Tex. Occ. Code §53.023.

Person's Information

1. Name:

2. SSN:

- -

DOB:Email:

Offense & Charge

3. Please state the exact crime for which

you were charged, convicted, or

received a deferred adjudication:

4. Date of offense:Date of conviction or deferred adjudication:

5. County and State of pending offense, conviction or deferred adjudication:

County:State:

6. Court:

(Example: 300th District Criminal Court or Federal Court)

7. Please describe the events and circumstances

that led to the charge:

(If you need more space, attach additional sheets.)

8. Sentence or action imposed by the court:

(Example: six months in Travis County Jail)

9. Are you currently on parole or probation?

YesNo

Certification of Responsibility

By signing below, I affirm I am the officer, director, partner, trustee, or other person acting in a representative capacity for the

applicant or license holder completing this form, and understand that if I fail to provide full and accurate information, the issuance of

my license could be delayed or denied.

Date:

Printed Name

Authorized Signature

Title

Privacy Statement

The Texas Department of Motor Vehicles maintains information collected through this form. With few exceptions, Texas Government Code Chapter 559 entitles

you to: (a) request to be informed about this information, and (b) have TxDMV correct information about you that is incorrect. Chapter 552 of the Government

Code entitles you to receive and review this information. You must submit requests for information in writing. Requests may be submitted via email to

[email protected]; by fax to (512) 465-4112; or by mail or in person to: TxDMV, OGC Open Records, 4000 Jackson Ave., Austin, TX 78731. For

more information, please call TxDMV at (888) 368-4689.