LA · rules
La. Code Crim. Proc. 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
History
Acts 2014, No. 145, §1; Acts 2018, No. 711, §1; Acts 2020, No. 73, §1.
Provenance
- Source
- legis.la.gov
- Retrieved
- 2026-09-15
- Edition
- 2026-09-15
- Content hash
a935334202da7c70e74d79d143c3cef58bc3e9e56f8ef6edda77f64d37dae123
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.