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Get LA DPSSP 0095 2012-2024

N APPLICATION INDIVIDUAL PERSONAL HISTORY PART B This form is authorized as outlined by the Tribal-State Compact. Disclosure of this information is REQUIRED by law. Failure to provide information could result in rejection or delay in processing this Application. Falsification of this Application may result in criminal arrest. DPSSP 0095 (R 06/2012) LOUISIANA DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONS OFFICE OF STATE POLICE INDIAN GAMING UNIT 2020 WEST PINHOOK RD., SUITE 504 LAFAYETTE, LA. .

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