SUPPLEMENTAL SHEET
____ Yes ____ NoARRESTS THAT DID NOT RESULT IN CONVICTION
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Time expired for prosecution | _____/____/_______ | |
(MM/DD/YYYY) | ||
() Charge refused by DA - not prosecuted. | ||
() Pre-trial Diversion Program. | ||
() Charge dismissed | ||
() Found not guilty/judgment of acquittal | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Time expired for prosecution | _____/____/_______ | |
(MM/DD/YYYY) | ||
() Charge refused by DA - not prosecuted. | ||
() Pre-trial Diversion Program. | ||
() Charge dismissed | ||
() Found not guilty/judgment of acquittal | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Time expired for prosecution | _____/____/_______ | |
(MM/DD/YYYY) | ||
() Charge refused by DA - not prosecuted. | ||
() Pre-trial Diversion Program. | ||
() Charge dismissed | ||
() Found not guilty/judgment of acquittal | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Time expired for prosecution | _____/____/_______ | |
(MM/DD/YYYY) | ||
() Charge refused by DA - not prosecuted. | ||
() Pre-trial Diversion Program. | ||
() Charge dismissed | ||
() Found not guilty/judgment of acquittal | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Time expired for prosecution | _____/____/_______ | |
(MM/DD/YYYY) | ||
() Charge refused by DA - not prosecuted. | ||
() Pre-trial Diversion Program. | ||
() Charge dismissed | ||
() Found not guilty/judgment of acquittal | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Time expired for prosecution | _____/____/_______ | |
(MM/DD/YYYY) | ||
() Charge refused by DA - not prosecuted. | ||
() Pre-trial Diversion Program. | ||
() Charge dismissed | ||
() Found not guilty/judgment of acquittal | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Time expired for prosecution | _____/____/_______ | |
(MM/DD/YYYY) | ||
() Charge refused by DA - not prosecuted. | ||
() Pre-trial Diversion Program. | ||
() Charge dismissed | ||
() Found not guilty/judgment of acquittal |
SUPPLEMENTAL SHEET
____ Yes ____ NoMISDEMEANOR CONVICTIONS
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 894(B) | ||
() More than 5 years have passed | ||
since completion of sentence. | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 894(B) | ||
() More than 5 years have passed | ||
since completion of sentence. | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 894(B) | ||
() More than 5 years have passed | ||
since completion of sentence. | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 894(B) | ||
() More than 5 years have passed | ||
since completion of sentence. | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 894(B) | ||
() More than 5 years have passed | ||
since completion of sentence. | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 894(B) | ||
() More than 5 years have passed | ||
since completion of sentence. | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 894(B) | ||
() More than 5 years have passed | ||
since completion of sentence. | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 894(B) | ||
() More than 5 years have passed | ||
since completion of sentence. | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 894(B) | ||
() More than 5 years have passed | ||
since completion of sentence. |
SUPPLEMENTAL SHEET
____ Yes ____ NoFELONY CONVICTIONS
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 893(E) | ||
() More than 10 years have passed | ||
since completion of sentence | ||
() Received a first offender pardon for an eligible offense | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 893(E) | ||
() More than 10 years have passed | ||
since completion of sentence | ||
() Received a first offender pardon for an eligible offense | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 893(E) | ||
() More than 10 years have passed | ||
since completion of sentence | ||
() Received a first offender pardon for an eligible offense | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 893(E) | ||
() More than 10 years have passed | ||
since completion of sentence | ||
() Received a first offender pardon for an eligible offense | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 893(E) | ||
() More than 10 years have passed | ||
since completion of sentence | ||
() Received a first offender pardon for an eligible offense | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 893(E) | ||
() More than 10 years have passed | ||
since completion of sentence | ||
() Received a first offender pardon for an eligible offense | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 893(E) | ||
() More than 10 years have passed | ||
since completion of sentence | ||
() Received a first offender pardon for an eligible offense | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 893(E) | ||
() More than 10 years have passed | ||
since completion of sentence | ||
() Received a first offender pardon for an eligible offense | ||
NO. ___ | La. Rev. Stat. Ann. | § _______ : ________ |
Name of the offense | _________________ | |
() Conviction set aside/dismissed | _____/____/_______ | |
(MM/DD/YYYY) | ||
pursuant to C.Cr.P. Art. 893(E) | ||
() More than 10 years have passed | ||
since completion of sentence | ||
() Received a first offender pardon for an eligible offense |
La. Cr.P. § 993