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      CCRP 993     

  

Art. 993.  Supplemental forms to be used


"

SUPPLEMENTAL SHEET

____ Yes ____  No

ARRESTS THAT DID NOT RESULT IN CONVICTION

ITEM 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

ITEM 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

ITEM 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

ITEM 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

ITEM 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

ITEM 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 ____  No

MISDEMEANOR CONVICTIONS

ITEM 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.

ITEM 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.

ITEM 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.

ITEM 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.

ITEM 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.

ITEM 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.

ITEM 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.

ITEM 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.

ITEM 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 ____  No

FELONY CONVICTIONS

ITEM 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

ITEM 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

ITEM 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

ITEM NO.

La. Rev. Stat. Ann.

§ _______ : ________

Name of the offense

_________________


since completion of sentence


ITEM 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


ITEM 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


ITEM 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


ITEM 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


ITEM 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

"


Acts 2014, No. 145, §1.



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