Texas Code § 724.031

STATEMENT REQUESTED ON REFUSAL
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Sec. 724.031. STATEMENT REQUESTED ON REFUSAL. If a person refuses the request of a peace officer to submit to the taking of a specimen, the peace officer shall request the person to sign a statement that:
(1) the officer requested that the person submit to the taking of a specimen;
(2) the person was informed of the consequences of not submitting to the taking of a specimen; and
(3) the person refused to submit to the taking of a specimen.

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