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
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