Vs145 - Texas
warning: the penalty for knowingly making a false statement in this form can be 2-10 years in prison and a fine of up to $10,000. (health and safety code, chapter 195, sec. 195.003) mail completed application, a check or money order for $10.00* payable to dshs. plus a copy of a valid government issued photo id to: department of state health ... ................
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