"General Disclosure Form" - Louisiana

General Disclosure Form is a legal document that was released by the Louisiana State Police - a government authority operating within Louisiana.

Form Details:

  • Released on August 1, 2018;
  • The latest edition currently provided by the Louisiana State Police;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Louisiana State Police.

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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
AGENCY, BUSINESS OR INDIVIDUAL NAME
INFORMATION, EXCLUDING
ADMINISTRATORS OR AUTHORIZED
PERSONS SIGNATURE.
MAILING ADDRESS
INCOMPLETE FORMS WILL NOT BE
PROCESSED.
CITY
STATE
ZIP CODE
NAME OF APPLICANT
DATE OF BIRTH
PLACE OF BIRTH
RACE / SEX
(STATE)
WEIGHT
HEIGHT
HAIR COLOR
EYE COLOR
SOCIAL SECURITY NUMBER
ALL INFORMATION RELEASED MUST REMAIN STRICTLY CONFIDENTIAL AND ONLY THOSE
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.
DATE
ARRESTING AGENCY
CONVICTION INFORMATION
______
____________________
______________________________________
______
____________________
______________________________________
______
____________________
______________________________________
______
____________________
______________________________________
______
____________________
______________________________________
Revised 08/2018
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
AGENCY, BUSINESS OR INDIVIDUAL NAME
INFORMATION, EXCLUDING
ADMINISTRATORS OR AUTHORIZED
PERSONS SIGNATURE.
MAILING ADDRESS
INCOMPLETE FORMS WILL NOT BE
PROCESSED.
CITY
STATE
ZIP CODE
NAME OF APPLICANT
DATE OF BIRTH
PLACE OF BIRTH
RACE / SEX
(STATE)
WEIGHT
HEIGHT
HAIR COLOR
EYE COLOR
SOCIAL SECURITY NUMBER
ALL INFORMATION RELEASED MUST REMAIN STRICTLY CONFIDENTIAL AND ONLY THOSE
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.
DATE
ARRESTING AGENCY
CONVICTION INFORMATION
______
____________________
______________________________________
______
____________________
______________________________________
______
____________________
______________________________________
______
____________________
______________________________________
______
____________________
______________________________________
Revised 08/2018