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2019 Louisiana Laws
Code of Criminal Procedure
Art. 993. Supplemental forms to be used

Universal Citation: LA Code Crim Pro art. 993 (2019)
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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

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

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

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

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

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

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

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

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; Acts 2018, No. 711, §1.

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