SCHEDULE F ADDENDUM Schedule F – This form must be completed by any applicant who has been convicted of a felony, and seeks lawful issuance of an alcohol beverage permit under the provisions of R.S. 26:80f and/or 26:280f. Applicant attests that the felony was not a crime of violence as defined in R.S. 14:2(13), and that ten (10) or more years have elapsed between the date of application and the successful completion of any sentence, deferred adjudication or period of probation, parole and the final discharge of the defendant. Applicant is required to submit official documentation of such at the time of application. IMPORTANT NOTICE A “CRIME OF VIOLENCE” is defined as any of the below-listed crimes. [R.S. 14.2(13)] If you have been convicted of ANY of the below-listed crimes, you will NOT qualify for an alcoholic beverage permit. CRIMES OF VIOLENCE 1. Solicitation for Murder 2. First Degree Murder 3. Second Degree Murder 4. Manslaughter 5. Aggravated Battery 6. Second Degree Battery 7. Aggravated Assault 8. Mingling Harmful Substances 9. Aggravated Rape 10. Forcible Rape 11. Simple Rape 12. Sexual Battery 13. Second Degree Sexual Battery 14. Intentional Exposure to AIDS Virus 15. Aggravated Kidnapping 16. Second Degree Kidnapping 17. Simple Kidnapping 18. Aggravated Arson 19. Aggravated Criminal Damage To Property 20. Aggravated Burglary 21. Armed Robbery 22. First Degree Robbery 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. Simple Robbery Purse Snatching Extortion Assault By Drive-by Shooting Aggravated Crime Against Nature Carjacking Illegal Use of Weapons or Dangerous Instrumentalities Terrorism Aggravated Second Degree battery Aggravated assault upon a peace officer with a firearm Aggravated assault with a firearm Armed Robbery; use of firearm; additional penalty Second Degree Robbery Disarming of a peace officer Stalking Second Degree Cruelty to Juveniles Aggravated Flight from an Officer Aggravated Incest Battery of a Police Officer Trafficking of Children for Sexual Purposes Human Trafficking Home Invasion American LegalNet, Inc. www.FormsWorkFlow.com 082110 State of Louisiana Office of Alcohol and Tobacco Control 8585 Archives Ave., Suite 220 P.O. Box 66404 Baton Rouge, LA 70896-6404 Telephone (225) 925-4041 · Fax (225) 925-3975 Bobby Jindal Governor Schedule F Application Date (paperwork initially submitted to this office, Agent etc.): Owner name of business (individual, partnership, corporation, LLC): Trade Name of Business: Type of Applicant: Individual Corporation LLC Partnership Limited Partnership (LP) Individual Information: Name (print/type full legal name) ID #, State (Driver’s License, State ID, etc) Phone Number (Primary Contact #) ( Date of Birth (month, day, & year) Age Sex Social Security Number ) - Race Charge/Conviction Information: Enter Type of Felony Conviction and Statute Number: Date of Conviction: Date of Final Discharge: I affirm that I have been convicted of felony, which is not considered a crime of violence as defined in R.S. 14:2(13), and that ten of more years have elapsed since the completion of sentence and final discharge. A copy of official documentation attesting this fact is attached hereto. Signature: Title: Print/Type your name: Sworn to and subscribed to me this in the parish/county of Notary Public’s Signature: day of , 20 State of Print Name of Notary Public: This form is to be completed by applicants that have been convicted of a felony, and seek lawful issuance of an alcohol beverage permit under the provisions of R.S. 26:80F and R.S. 26:280F. Applicant attests that the felony was not a crime of violence as defined in R.S. 14:2 (13) and that ten of more years have elapsed between the date of application and the successful completion of any sentence, deferred adjudication, or period of probation or parole and the final discharge of the defendant. Applicant is required to submit official documentation of pardon, restoration of rights, or official certification that ten years or more have elapsed since successful completion of any sentence, deferred adjudication, or period of probation or parole and the final discharge of the defendant at the time of application. American LegalNet, Inc. www.FormsWorkFlow.com