STATE OF TEXAS	 §
 § COUNTY OF ____________________________	 §

BEFORE	ME,	the	undersigned	authority,	personally	appeared

 	, who being duly sworn, deposed as follows:

"My name is                                                                 .  I am at least 18 years of age and of sound mind..  I  have  read  the  attached  pleading  requesting  this  Court  to  approve  an occupational license.     The facts set forth in the attached pleading requesting this Court to approve an occupational license and the facts set forth in this affidavit are based on person knowledge and are true and correct.
2.	My	driver's   license   was	suspended   on    	,	for   a   period	of

                                due to a conviction for an offense under Sections 49.04-49.08 Penal Code, and  I have been restricted to the operation of a motor vehicle equipped with an ignition interlock device.  I have not been issued, in the 10 years preceding the date of the filing of the attached petition, more than one occupational license after a conviction under the laws of this state. I currently reside in Montgomery County; or I am seeking an occupational license as a result of my license having been suspended pursuant to an incident that occurred in Montgomery County.
3.          I  have  a  valid  policy  of  automobile  liability  insurance  in  accordance  with  the

provisions of Section 601.071, et seq., of the Texas Transportation Code.  A true and correct copy of evidence of my insurance is attached to this affidavit as Exhibit "A."

4.	I have an ignition interlock device installed on each motor vehicle I own or operate, installed by (Petitioner shall initial one provider):

 	Smart Start	 	AZ Interlock	 	Interlock Systems of Texas

 	Intoxalock	 	LifeSafer

 	Draeger

A true and correct copy of evidence of my interlock installation is attached to this affidavit

as Exhibit "B." Further Affiant sayeth not."

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on the  	day of  	,
20 	, to certify which witness my hand and official seal.

 	_ Notary Public in and for the State of Texas