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Get Fee Affidavit Form - Texas Department Of Criminal Justice - Tdcj State Tx

FEE AFFIDAVIT FORM Original CLIENT Supplemental PIA/TDCJ S.I. D. ATTORNEY INFORMATION MR./MS. FIRST NAME MIDDLE LAST NAME SUFFIX ADDRESS TEXAS BAR NO. NAME OF BUSINESS BUSINESS ADDRESS BUSINESS PHONE CITY BUSINESS FAX STATE ZIP BCJ-BPP-TDCJ FORMER OR CURRENT EMPLOYEE S OR MEMBERS WITH WHICH ATTORNEY IS ASSOCIATED OR HAS A RELATIONSHIP AS AN EMPLOYER OR EMPLOYEE OR MAINTAINS A CONTRACTUAL RELATIONSHIP TO PROVIDE SERVICES LIST ADDITIONAL NAMES ON BACK. ENTITY HAVE YOU REGISTERED WITH THE TDCJ-PAROLE DIVISION WITHIN THE LAST 12 MONTHS YES/NO TEX. GOV T. CODE 508. 084 and 508. 085 require certain information relative to fees or lack thereof* This affidavit must be completed in regards to the relevant areas signed sworn and subscribed to before a Notary Public prior to any representation* I. NO FEE I OR ANY CORPORATION OR FIRM WITH WHICH I AM AFFILIATED HAVE RECEIVED NO FEE NOR PROMISE OF FEE FOR SERVICES OF ANY NATURE RENDERED OR TO BE RENDERED IN CONNECTION WITH PAROLE OR EXECUTIVE CLEMENCY FOR THE ABOVE NAMED PERSON* Signature Printed Name II. COMPENSATED REPRESENTATION TEXAS GOVERNMENT CODE 305. 002 DEFINES COMPENSATION AS MEANING MONEY SERVICE FACILITY OR OTHER THING OF VALUE OR FINANCIAL BENEFIT THAT IS RECEIVED OR IS TO BE RECEIVED IN RETURN FOR OR IN CONNECTION WITH SERVICES RENDERED OR TO BE RENDERED. representing an offender subject to the jurisdiction of the Texas Department of Criminal Justice. AMOUNT OF COMPENSATION RECEIVED OR EXPECTED THE PERSON MAKING THE COMPENSATION PHONE STREET ADDRESS I HEREBY SWEAR OR AFFIRM THAT THE ABOVE INFORMATION IS TRUE AND CORRECT AND FURTHERMORE I HEREBY AGREE TO IMMEDIATELY SUPPLEMENT THIS AFFIDAVIT IF ANY OF THE STATEMENTS MADE HEREIN ARE AFFECTED BY A CHANGE IN FEE AGREEMENT OR ARRANGEMENT OR FACTUAL CONDITIONS* SIGNATURE DATE SWORN TO AND SUBSCRIBED BEFORE ME THE UNDERSIGNED AUTHORITY UNDER PENALTY OF PERJURY ON THIS THE DAY OF A*D* 20. SEAL SIGNATURE OF HEARING OFFICER OR NOTARY PUBLIC IN AND FOR THE STATE OF TEXAS RRP-12 Rev* 10/09. NAME OF BUSINESS BUSINESS ADDRESS BUSINESS PHONE CITY BUSINESS FAX STATE ZIP BCJ-BPP-TDCJ FORMER OR CURRENT EMPLOYEE S OR MEMBERS WITH WHICH ATTORNEY IS ASSOCIATED OR HAS A RELATIONSHIP AS AN EMPLOYER OR EMPLOYEE OR MAINTAINS A CONTRACTUAL RELATIONSHIP TO PROVIDE SERVICES LIST ADDITIONAL NAMES ON BACK. ENTITY HAVE YOU REGISTERED WITH THE TDCJ-PAROLE DIVISION WITHIN THE LAST 12 MONTHS YES/NO TEX. GOV T. ENTITY HAVE YOU REGISTERED WITH THE TDCJ-PAROLE DIVISION WITHIN THE LAST 12 MONTHS YES/NO TEX. GOV T. CODE 508. 084 and 508. 085 require certain information relative to fees or lack thereof* This affidavit must be completed in regards to the relevant areas signed sworn and subscribed to before a Notary Public prior to any representation* I. CODE 508. 084 and 508. 085 require certain information relative to fees or lack thereof* This affidavit must be completed in regards to the relevant areas signed sworn and subscribed to before a Notary Public prior to any representation* I. NO FEE I OR ANY CORPORATION OR FIRM WITH WHICH I AM AFFILIATED HAVE RECEIVED NO FEE NOR PROMISE OF FEE FOR SERVICES OF ANY NATURE RENDERED OR TO BE RENDERED IN CONNECTION WITH PAROLE OR EXECUTIVE CLEMENCY FOR THE ABOVE NAMED PERSON* Signature Printed Name II.

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