TEXAS COMMI SSI ON ON LAW ENFORCEMENT

6330 E. Hi ghway 290, STE. 200

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http://www.tcleose.state.tx.us
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Submit PID Assignment form if TCO! PID has not been issue". Call #$%&' ()*+,,-- if .uestions.
A))LICANT INFORMATION
%. TCO! PID
/e.uire"
&. ast 0ame ). 1i r st 0ame 2. 3. I . $. Suffix #4r.5 etc.'
*. Dat e of 6i r t h
/ /
,. 7ome or Per manent 3ai l i ng A""r ess 8. Cit9: (. State
%-. :ip Co"e %%. Phone 0umber #inclu"e area co"e'
7ome:
Cell:
%&. !+3ail
A440i2a!s 3us 6" a :ua0i1i"/ ."i."/ 0aw "!1*.2"3"! *11i2"., ."si/i!g i! T"#as, wh* a." "!i0"/ * 2a..y a
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Ch"29 a00 ha a440y
/etire" 1e"eral Officer #as "esignate" in %,-%.)$, of the Texas Occupations Co"e'
/etire" Out+of+State Officer
Initial Application #1irearms Proficienc9 expires %& months from .ualification month'
/enewal / Duplicate Application #Photo on file will be use". Attach current certificate of firearms proficienc9'
NOTE+ Application for renewal shoul" be ma"e 2$ "a9s prior to renewal. Current car"s expiration "ate;;;;;;;;;.
To .ualif95 an applicant for a /etire" 1e"eral/Out+of+State Peace Officer 1irearms Proficienc9 Certificate must meet all
proficienc9 re.uirements inclu"ing submission of:
#%' Certifie" or notari<e" cop9 of retire" cre"entials as:
#a' a peace officer from another state of the =nite" States>
#b' a fe"eral criminal in?estigator "esignate" as a special in?estigator un"er Article &.%&&5 CCP> or
#c' a .ualifie" retire" law enforcement officer who is entitle" to carr9 a conceale" firearm un"er %8 =.S.C. Section (&*C
an" is not otherwise "escribe" b9 Sub"i?ision #%' or #&'.
#&' A sworn affi"a?it stating:
#a' the officer honorabl9 retire" after not less than a total of %$ 9ears of ser?ice as a commissione" officer with one or
more state or local law enforcement agencies>
#b' the officer@s license as a commissione" officer was not re?oAe" or suspen"e" for an9 perio" "uring the officer@s term
of ser?ice as a commissione" officer>
#c' retire" from ser?ice with such agenc95 after completing an9 applicable probationar9 perio" of such ser?ice5 "ue to a
ser?ice+connecte" "isabilit95 as "etermine" b9 such agenc9> an"
#"' the officer has no ps9chological or ph9sical "isabilit9 that woul" interfere with the officer@s proper han"ling of a
han"gun>
#)' A color passport photo with applicantBs signature on bacA> an"
#2' 3eet the firearms proficienc9 re.uirements for han"gun as establishe" in Commission /ule C&%,.&%#c'#%'.
I5 the applicant5 attest that I meet the re.uirements for issuance of a /etire" 1e"eral/Out+of+State Officer 1irearms Proficienc9
#%,-%.)$, OC' an" ha?e inclu"e" the non+refun"able D)$ fee.
I5 the applicant5 am full9 aware that this application is a go?ernment "ocument an"5 un"er penalt9 of perEur95 I "eclare the foregoing
information to be true an" correct.
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Signature of Applicant Date
/etire" 1e"eral or Out of State Officer 1irearms Certificate ,.-%.&-%) Page 1 of &
CERTIFICATE OF FIREARMS )ROFICIENC<
#Commission /ule C&%,.&%#c'#%'
A440i2a!
1irst 0ame 3.I. ast 0ame TCO! PID
Fi."a.3s I!s.u2*.
1irst 0ame 3.I. ast 0ame TCO! 1irearms Instructor
C7 Instructor F;;;;;;;;;;;;;;;;
aw !nforcement Agenc9/6usiness 0ame 3ailing A""ress
Cit9 Count9 :ip Co"e Telephone 0umber
/ange ocation #if other than the abo?e a""ress' Date of Gualification
I5 ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;5 certif9 that the abo?e+name" applicant has met the minimum
1irearms/C7 Instructor
1irearms proficienc9 re.uirements as establishe" in Commission /ule C&%,.&% #c'#%' un"er the following con"itions:
#%' 6+&, or similar silhouette target>
#&' Combat scoring>
#)' A minimum of $- roun"s5 inclu"ing at least fi?e roun"s of "ut9 ammunition>
#2' 1ire" at ranges from point blanA to at least %$ 9ar"s with a least &- roun"s at or be9on" se?en 9ar"s>
#$' Inclu"ing at least one time" reloa"> an"
#*' 3inimum passing percentage of ,- #%,$ out of a possible &$- for $- roun"s'.
I am full9 aware that this firearms proficienc9 certification is a go?ernment "ocument an"5 un"er penalt9 of perEur95 I
"eclare the foregoing information to be true an" correct.
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Signature of 1irearms/C7 Instructor Date
A11i/a=i
I5 ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;5 "o swear or affirm that I meet the re.uirements establishe" in the Texas
Applicant
Occupations Co"e C%,-%.)$, Heapons Proficienc9 for Certain /etire" Peace Officers an" 1e"eral Criminal In?estigators
an" Chapter 225 Title %85 =nite" States Co"e5 Section (&*C#c' Gualifie" /etire" aw !nforcement Officers. I am
honorabl9 retire" #benefits eligible' after not less than a total of %$ 9ears of ser?ice as a commissione" peace officer with
one or more state or local law enforcement agencies or fe"eral criminal in?estigator as "esignate" b9 the Texas Co"e of
Criminal Proce"ure Article &.%&&.5 or a .ualifie" retire" law enforcement officer un"er Chapter 225 Title %85 =nite" States
Co"e5 Section (&*C.
39 license or authorit9 as a commissione" officer was ne?er re?oAe" or suspen"e" for an9 perio" "uring m9 term of
ser?ice as a commissione" officer. I was not retire" for reasons of mental instabilit9 an" ha?e no ps9chological or
ph9sical "isabilit9 that woul" interfere with the proper han"ling of a han"gun. I ha?e met the minimum .ualifications for a
han"gun as establishe" in Commission /ule C&%,.&%#c'#%'.
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Signature of Applicant Date
Sworn to an" ascribe" before me the un"ersigne" official on this ;;;;;;;;;;;;"a9 of ;;;;;;;;;;;;;;5 ;;;;;;;;;.
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0otar9 Public
/etire" 1e"eral or Out of State Officer 1irearms Certificate ,.-%.&-%) Page 2 of &