Art. 993. Supplemental forms to be used
SUPPLEMENTAL SHEET
____ Yes ____ No ARRESTS 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
SUPPLEMENTAL SHEET
____ Yes ____ No MISDEMEANOR 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 ____ No FELONY 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
Acts 2014, No. 145, §1; Acts 2018, No. 711, §1; Acts 2020, No. 73, §1.