STATE OF TEXAS DRIVING SAFETY COURSE UNIFORM CERTIFICATE OF COMPLETION
COURT COPY
This certifies that the student named herein has successfully completed a six (6) hour driving safety course that is approved and regulated by the Texas Department of Licensing and Regulation.
This certificate’s validity can be verified within 5 days of the issuance date at www.tdlr.texas.gov/DESSearch
Under penalty of perjury, I certify that I have received six (6) hours of instruction.
If you have reason to believe this certificate is not valid or the driving safety course taken did not meet the requirements in Texas
Administrative Code Chapter 84 or Texas Education Code Chapter 1001, please file a complaint with TDLR at
www.tdlr.texas.gov/complaints or mail to 920 Colorado St, Austin, TX 78701.
Court Information:
Court Name
Changed from:A Different City Court
Student Name and Mailing Address:
123 Austin St
Austin, TX 78752
Smith, Johnny
1 Address
Arisona, TN 54321
WARNING: Altering, tampering, forgery or misuse of the certificate may result in criminal fines up to $10,000 and/or up to 5 years imprisonment under the Texas Penal Code and Texas Education Code.
CERTIFICATE# CP000-26655181
Changed from:CP000-26655180
Student Name:
Student Everyman
Changed from:Smith, Johnny
Student DL No:
TX 00000000
Changed from:TX 000000001
Student DOB:
mm/dd/yyyy
Changed from:mm/dd/yyyy
Provider:
CP090 – Driver Training Associates, Inc.
Completion Date:
mm/dd/yyyy
Issue Date:
mm/dd/yyyy
Reason:
Sample Reason
Changed from:Other Reason
STATE OF TEXAS DRIVING SAFETY COURSE UNIFORM CERTIFICATE OF COMPLETION
INSURANCE COPY
This certifies that the student named herein has successfully completed a six (6) hour driving safety course that is approved and regulated by the Texas Department of Licensing and Regulation.
This certificate’s validity can be verified within 5 days of the issuance date at www.tdlr.texas.gov/DESSearch
Under penalty of perjury, I certify that I have received six (6) hours of instruction.
If you have reason to believe this certificate is not valid or the driving safety course taken did not meet the requirements in Texas
Administrative Code Chapter 84 or Texas Education Code Chapter 1001, please file a complaint with TDLR at
www.tdlr.texas.gov/complaints or mail to 920 Colorado St, Austin, TX 78701.
Student Name and Mailing Address:
123 Austin St
Austin, TX 78752
Smith, Johnny
1 Address
Arisona, TN 54321
WARNING: Altering, tampering, forgery or misuse of the certificate may result in criminal fines up to $10,000 and/or up to 5 years imprisonment under the Texas Penal Code and Texas Education Code.
CERTIFICATE# CP000-26655181
Changed from:CP000-26655180
Student Name:
Student Everyman
Changed from:Smith, Johnny
Student DL No:
TX 00000000
Changed from:TX 000000001
Student DOB:
mm/dd/yyyy
Changed from:mm/dd/yyyy
Provider:
CP090 – Driver Training Associates, Inc.
Completion Date:
mm/dd/yyyy
Issue Date:
mm/dd/yyyy
Reason:
Sample Reason
Changed from:Other Reason