Get LA General Disclosure Form LSPAPP3 2018-2022

ATN and SID FOR OFFICIAL USE ONLY ATN SID APPLICANT PROCESSING DISCLOSURE BUREAU OF CRIMINAL IDENTIFICATION AND INFORMATION P. O. BOX 66614 MAIL SLIP A-6 BATON ROUGE LA 70896 NOTICE PLEASE PRINT OR TYPE ADMINISTRATORS OR AUTHORIZED PERSONS SIGNATURE* AGENCY BUSINESS OR INDIVIDUAL NAME MAILING ADDRESS CITY STATE NAME OF APPLICANT WEIGHT ZIP CODE INCOMPLETE FORMS WILL NOT BE PROCESSED. DATE OF BIRTH PLACE OF BIRTH RACE / SEX HAIR COLOR EYE COLOR SOCIAL SECURITY NUMBER AUTHORIZED BY LAW TO RECEIVE THIS INFORMATION MAY SUBMIT A REQUEST. DO NOT WRITE BELOW THIS LINE For Bureau of Criminal Identification and Information Use Only NOTICE The response to your request for a criminal history check is based on a review of the State of Louisiana s criminal history records database as is available at the time of request. This does not preclude the possible existence of an arrest or conviction information not available in our database. O. BOX 66614 MAIL SLIP A-6 BATON ROUGE LA 70896 NOTICE PLEASE PRINT OR TYPE ADMINISTRATORS OR AUTHORIZED PERSONS SIGNATURE* AGENCY BUSINESS OR INDIVIDUAL NAME MAILING ADDRESS CITY STATE NAME OF APPLICANT WEIGHT ZIP CODE INCOMPLETE FORMS WILL NOT BE PROCESSED. DATE OF BIRTH PLACE OF BIRTH RACE / SEX HAIR COLOR EYE COLOR SOCIAL SECURITY NUMBER AUTHORIZED BY LAW TO RECEIVE THIS INFORMATION MAY SUBMIT A REQUEST. DATE OF BIRTH PLACE OF BIRTH RACE / SEX HAIR COLOR EYE COLOR SOCIAL SECURITY NUMBER AUTHORIZED BY LAW TO RECEIVE THIS INFORMATION MAY SUBMIT A REQUEST. DO NOT WRITE BELOW THIS LINE For Bureau of Criminal Identification and Information Use Only NOTICE The response to your request for a criminal history check is based on a review of the State of Louisiana s criminal history records database as is available at the time of request. DO NOT WRITE BELOW THIS LINE For Bureau of Criminal Identification and Information Use Only NOTICE The response to your request for a criminal history check is based on a review of the State of Louisiana s criminal history records database as is available at the time of request. This does not preclude the possible existence of an arrest or conviction information not available in our database. O. BOX 66614 MAIL SLIP A-6 BATON ROUGE LA 70896 NOTICE PLEASE PRINT OR TYPE ADMINISTRATORS OR AUTHORIZED PERSONS SIGNATURE* AGENCY BUSINESS OR INDIVIDUAL NAME MAILING ADDRESS CITY STATE NAME OF APPLICANT WEIGHT ZIP CODE INCOMPLETE FORMS WILL NOT BE PROCESSED. DATE OF BIRTH PLACE OF BIRTH RACE / SEX HAIR COLOR EYE COLOR SOCIAL SECURITY NUMBER AUTHORIZED BY LAW TO RECEIVE THIS INFORMATION MAY SUBMIT A REQUEST. DO NOT WRITE BELOW THIS LINE For Bureau of Criminal Identification and Information Use Only NOTICE The response to your request for a criminal history check is based on a review of the State of Louisiana s criminal history records database as is available at the time of request. DATE OF BIRTH PLACE OF BIRTH RACE / SEX HAIR COLOR EYE COLOR SOCIAL SECURITY NUMBER AUTHORIZED BY LAW TO RECEIVE THIS INFORMATION MAY SUBMIT A REQUEST. DO NOT WRITE BELOW THIS LINE For Bureau of Criminal Identification and Information Use Only NOTICE The response to your request for a criminal history check is based on a review of the State of Louisiana s criminal history records database as is available at the time of request. This does not preclude the possible existence of an arrest or conviction information not available in our database. .