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Certification Letter for Victim of Family Violence Waiver for Electric and Telephone Service Deposit

Texas · TexasLawHelp.org

This form is used by certain organizations to officially state that a person is a victim of family violence. This certification helps the person prove they are trustworthy enough to get electric and telephone service without having to pay a security deposit.

The court describes it as: Certifying entities can use this form to certify victims of family violence, establishing creditworthiness for electric/telephone service.

Open the official PDFfrom TexasLawHelp.org

Where this fits in a case

General & info

Information / general use — not tied to one step of a case

This form is used when a person needs to establish electric or telephone service and needs to waive the usual deposit requirement because they are a victim of family violence.

Prepared by the court or clerk.

Common questions

Who fills out this form?
The form must be completed by a 'Certifying Entity,' which can be a Family Violence Center, medical personnel, law enforcement, or the Attorney General's office.
What does this form prove?
It proves that the person listed is a victim of family violence as defined by Texas Family Code §71.004.
Is this for a court case?
No, this form is for certifying status to waive a service deposit for electric and telephone service.

Revision history

No changes recorded since we started tracking this form on October 9, 2026.

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