Arson Registry Online Submission Form - Louisiana Office of State Fire Marshal

ARSON REGISTRY ONLINE SUBMISSION FORM

Please follow the instructions very carefully, reading all the questions thoroughly before submitting. If any information is unknown, leave blank and go on to the next block.

Offender's Information

First Name

Middle Initial

Last Name

Suffix

Social Security #

Driver's License or ID#

Date of Birth

Alias(es)

Street Address

City

Zip

Contact Phone

Other Phone

Height

Weight (pounds)

Hair Color

Eye Color (other)

Ethnicity (other)

Distinguishing Marks

Tattoo(s)

Scar(s)

Other

Distinguishing Marks Comments

Employment Information

Convicted Crime Information

Vehicle 1 Make

Vehicle 1 Model

If the vehicle is two-tone, please list the colors:

Vehicle 1 Make

Vehicle 1 Model

If the vehicle is two-tone, please list the colors:

Vehicle 1 Make

Vehicle 1 Model

If the vehicle is two-tone, please list the colors:

Convicted Crime Information

Date of Conviction

Judicial District of Conviction

Docket or Case Numbers

Date of Sentence(s)

Imposed Sentence(s)

Attachments

Current Photograph

Driver’s License or State ID

Proof of Residence, Utility bill, etc. or affidavit

Other

Reporting Agency Information

Date Reported

Reporting Agency

Street Address

City

State

Zip

Agency Phone

Person Filing Report