Application for Pardon Consideration

1. You have been convicted of a violation of Louisiana law, either a felony or misdemeanor.
2. You have no pending charges, outstanding detainers, or any pecuniary penalties or liabilities which total more than $1,000 and result from any criminal conviction or traffic infraction.
3. You have paid all court costs which were imposed in connection with the conviction of the crime(s) for which pardon is requested.
4. You have paid all victim restitution, including but not limited to, restitution pursuant to a court or civil judgment or by order of the Committee on Parole.
5. You are not currently in jail or prison.
6. You must have discharged all sentences, including any type of supervision.
7. You cannot have been considered for a Pardon within the past two years.

1. Complete all required questions on this form.
2. It is the applicant’s responsibility to submit a completed application. The application will not be processed until it is complete. If the application is not complete, the applicant will be notified about the missing information.
3. Each question must be answered fully, truthfully, and accurately.
4. Additional documentation that is relevant to the application may also be attached, including:
   
   • Letters of support on behalf of the applicant with the application.
   • If the applicant was in the military, include the military's DD-214 with the application.
   • Other attachments that the applicant would like to include may be attached.
5. Application forms must be filled out completely, signed, dated, and notarized where required.
6. The submission of any false information is grounds for immediate denial of the application.

APPLICANTS SHOULD KEEP A COPY OF THE COMPLETE APPLICATION AND ANY ADDED ATTACHMENTS!

1. Certified Judgment & Sentence on each conviction you wish to have Pardoned (obtainable from the Court Clerk in the Parish of conviction; copies must bear the Clerk’s Seal);
2. Certified statement from the Court Clerk that all restitution, fines, fees, and court costs have been paid in full (must bear the Clerk’s Seal).
3. Current credit report (current within 90 days) (www.freeannualcreditreport.com);
4. Proof of employment or income (if you receive any income send a copy of the latest statement showing the type of income and the amount, i.e. unemployment or SSI); and
5. Proof of residence (current receipt for rent or mortgage payments, lease agreement, or property tax assessment – NOT utility/cable bills).
6. Certified Copy of First Offender Pardon (if applicable)

Application for pardon after completion of sentence

Offense(s) for which pardon is sought

Relief Requested and Reason(s) for Seeking a Pardon

Prior and Subsequent Criminal Record

Biographical Information

Substance Abuse and Mental Health Information

Civil and financial information

Military Record

Occupational Licensing

Charitable and community activities

Certification and Personal Oath

Authorization for Release of Information

Carefully read this authorization to release information about you, then complete, sign and date it. I authorize any duly accredited representative of the Louisiana Pardon and Parole Board or the Louisiana Department of Corrections, to obtain any information relating to my activities from schools, residential management agents, employers, criminal justice agencies, retail business establishments, courts, or other sources of information. This information may include, but is not limited to, my academic, residential, achievement, performance, attendance, disciplinary, employment history, criminal history, arrest, conviction, including the pre-sentence investigation report, if any, medical, psychiatric/psychological, health care, financial and credit information.

I understand that, for financial or lending institutions and certain other sources of information, a separate specific release may be needed (pursuant to their request or as may be required by law), and I may be contacted for such a release at a later date.

I further authorize the Louisiana Pardon and Parole Board or the Louisiana Department of Public Safety & Corrections, or any other authorized state agency, to request criminal record information about me from criminal justice agencies for the purpose of determining my suitability for a Pardon.

I authorize custodians of records and sources of information pertaining to me to release such information upon request of any duly accredited representative of the Louisiana Pardon and Parole Board or the Louisiana Department of Public Safety & Corrections or any state agency authorized above regardless of any previous agreement to the contrary.

I understand that the information released by records custodians and sources of information is for official use by the State of Louisiana only for the purposes of processing my application for a pardon, and may be re-disclosed by the State of Louisiana only as authorized by law.

I understand that pursuant to Act 52 of the 2016 Legislative session, should my application advance to Stage 2 of the process, I agree to pay an assessment fee of $150.00 to the Louisiana Department of Public Safety & Corrections for a clemency investigation to be conducted by the Division of Probation & Parole.

Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid for one (1) year from the date signed.

Character affidavit on behalf of