Fillable Printable Sample Texas Residency Affidavit
Fillable Printable Sample Texas Residency Affidavit
Sample Texas Residency Affidavit
Notarization (if required) may be provided in the space below
DL-5 (Rev. 2/13)
Texas Residency
Affidavit
Instructions for completion are on back of form
To be eligible for a Texas driver license or identication card, the applicant must be a resident of or domiciled in Texas.
If the applicant cannot provide two acceptable residency documents from the list found on the back of this form, this
affidavit may be used as evidence of residency in Texas.
*Texas domicile rules are in the Texas Administrative Code (37 TAC §§ 15.49 and 16.15).
The applicant for a Texas driver license or identication card must complete Section A.
A. Applicant Information
Name
Residence Address City State ZIP Code
I certify that the information provided above is true and correct. I understand that according to Texas law, it is a crime
to knowingly make any false statement relating to the application for a driver license or identication card.
Applicant’s Signature Date
A representative who provides services to the applicant at the address in Section A must complete Section B certifying
that the applicant resides or receives services at that address.
The individual who resides at the address in Section A must complete Section B certifying that the applicant resides at
that address and provide two acceptable documents establishing proof of residency. If the individual who completes
Section B is not related to the applicant, they must accompany the applicant and submit this affidavit in person.
B. Individual or Representative Information
Name of Individual or Representative
If a representative, please provide the affiliate organization
Business or Residence Address City State ZIP Code
The applicant and the individual or representative must sign Section B.
The individual or representative for the applicant must certify and sign the following section. I certify the information
submitted on behalf of the above applicant is true and correct. The applicant does live at my residence or receives
services at the location listed above. I understand that according to Texas law, it is a crime to knowingly make any false
statement relating to application for a driver license or identication card.
Certier’s Signature Date
Instructions
The applicant must use this affidavit to support their claim of residency or being domiciled in Texas. This form and any proof
submitted do not guarantee the issuance of a Texas driver license or identication card.
1. The form must be complete, legible, and signed by the applicant and the individual or representative.
2. Provide copy of two acceptable documents to support the applicant’s claim of residence or domicile in Texas.
3. For individuals who are related, provide copies of two acceptable residency documents, document(s) demonstrating
family relationship, and the signed affidavit. Acceptable documents demonstrating family relationship may include,
but are not limited to:
Marriage license Military dependent identication card
Birth certicate Adoption records
4. For individuals who are non-family, provide copies of two acceptable residency documents and the signed affidavit.
The individual must accompany the applicant and present a valid Texas driver license or identication card.
5. A representative of a governmental entity, not-for-prot organization, assisted care facility/home, adult assisted living
facility/home, homeless shelter, transitional service provider, or group/half way house must provide a notarized letter
certifying to the address where the applicant resides or receives services and verifying they receive mail for the applicant
in lieu of two acceptable residency documents. This representative is not required to accompany the applicant.
6. An applicant is not required to comply with this section if they are subject to the address condentiality program
administered by the Office of the Attorney General or currently incarcerated in a Texas Department of Criminal Justice
facility.
7. DPS determines if submitted documents are acceptable and has the authority to reject or require additional evidence
to verify residence address.
Acceptable residency documents:
The following are acceptable as long as they include the name of the applicant and their Texas residential address and
show the applicant has lived in Texas for at least 30 days prior to application:
Current deed, mortgage, monthly mortgage statement, mortgage payment booklet, or a residential rental/lease
agreement
Valid, unexpired Texas voter registration card
Texas motor vehicle registration or title
Texas boat registration or title
Texas concealed handgun license
An electric, water, natural gas, satellite television, cable television, or non-cellular telephone statement dated within
90 days of the date of application
Selective Service card
Current homeowner’s or renter’s insurance policy or homeowner’s or renter’s insurance statement or current
automobile insurance policy or an automobile insurance statement
Texas high school, college, or university report card or transcript for the current school year
W-2 or 1099 tax form from the current tax year
Mail from nancial institutions; including checking, savings, investment account, and credit card statements dated
within 90 days of the date of application
Mail from a federal, state, county, or city government agency dated within 90 days of the date of application
Current automobile payment booklet
Current documents issued by the US military indicating residence address
Document from the Texas Department of Criminal Justice indicating the applicant's recent release or parole
Medical or health card
Pre-printed paycheck or payment stub dated within 90 days of the date of application
Current Form DS2019, I-20, or a document issued by the United States Citizenship and Immigration Services
(non-commercial driver license and identication cards only)
