| STATEMENT OF ASSURANCE | |||||||
| I, _______ _____, hereby make the following Assurances to DefensiveDriving.com and the Driver Training Division of the Texas Education Agency: | |||||||
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	 _____________________________________________ (Student Signature)  | |||||||
| Before me, the undersigned authority, on this day personally appeared: | |||||||
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_____________________________________________ known to me to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he/she signed the same for the purpose and consideration therein expressed. 
 Given under my hand and seal of office, on the _______ of __________________, 20____.  | |||||||
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| Signature of Notary Public  in and for the State of ___________.  |  |||||||
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