La. Code Crim. Proc. art. 993 — LA Code / Code code-of-criminal-procedure / Article 993
Supplemental forms to be used
Status: in_force

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.

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.