Form Tcfp 004 R2 – Fill Out and Use This PDF

Confirmation of Commission

AFFIDAVIT OF TCLEOSE COMMISSION

(To be completed by the individual that is authorized by TCLEOSE to commission Law Enforcement Officers.)

State of Texas
County of
I, (print name)	am the recognized and authorized person to commission Peace

Officers as identified by the Texas Commission on Law Enforcement Officer Standards & Education and as such, I am

the (title)

of the above named

Political Subdivision

or State Agency and do hereby

confirm that (name of Investigator)

is a

duly COMMISSIONED PEACE

OFFICER in this jurisdiction.

IN TESTIMONY WHEREOF, I have hereto set my hand this

day of

A.D.

________________________________

Signature

INVESTIGATOR AFFIDAVIT

Social Security No.	Last Name	Suffix	First Name	Middle Name or
				Initial

(To be completed by the Applicant.)

State of Texas

County of

I, do hereby solemnly swear that I am a duly licensed peace officer of the State of Texas and that I have been Commissioned as a PEACE OFFICER for the above jurisdiction and that I have taken the prescribed Oath of Office as such.

IN TESTIMONY WHEREOF, I have hereto set my hand this day ofA.D. .

________________________________

Signature

Purpose: This form must accompany all applications for arson investigator certification (TCFP-002). Anytime there is a change in the entity that holds an arson investigator’s peace officer commission, a new Confirmation of Commission (TCFP-004) must be submitted by the arson investigator. The commission will not reflect an arson investigator’s certification as active without a current Confirmation of Commission on file.

Date Received: Reserved for agency use.

Date Processed: Reserved for agency use.

Processed By: Reserved for agency use.

FDID No.: The identification number assigned to the department by the commission.

Department Name: The name of the department that holds the individual’s TCLEOSE commission as a peace officer.

AFFIDAVIT OF TCLEOSE COMMISSION

This section of the form is to be completed by the individual that is authorized by TCLEOSE to commission law enforcement officers.

County of: The name of the county where the entity is located.

(print name): The name of the individual that is the TCLEOSE authorized individual who holds the commissions of law enforcement officers for the entity.

(title): The title of the individual named above.

(name of investigator): Name of the individual arson investigator being certified.

(date): Date of the action

Signature: Signature of the individual attesting the information.

INVESTIGATOR AFFIDAVIT

This section of the form is to be completed by the applicant.

Social Security Number: Applicant’s social security number.

Last Name: Applicant’s last name

Suffix: Jr., Sr., III etc.

First Name: Applicant’s first name.

Middle name or initial: Applicant’s middle name or initial, if applicable.

County of: Name of the county where the entity is located.

(date): Date of the action.

Signature: Legal signature of the individual attesting to the information.