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DD FORM 261 OCT 95 EG PREVIOUS EDITION WILL BE USED. Designed using Perform Pro WHS/DIOR Oct 95 Reset 17. 1. REPORT DATE YYMMDD REPORT OF INVESTIGATION LINE OF DUTY AND MISCONDUCT STATUS 2. INVESTIGATION OF X one INJURY 3. STATUS X as applicable DISEASE ILLNESS DEATH a* REGULAR OR EAD 4. TO Major Army or Air Force Commander b. CALLED OR ORDERED TO AD FOR 1 MORE THAN 30 DAYS 2 30 DAYS OR LESS 5. NAME OF INDIVIDUAL Last First Middle Initial 6. SSN 7. GRADE c* INACTIVE DUTY TRAINING Type 8. ORGANIZATION AND STATION d. SHORT TOUR OF ACTIVE DUTY FOR TRAINING 9. OTHER MILITARY PERSONNEL INVOLVED IN THE SAME INCIDENT NAME Last First Middle Initial a* SSN b. c* d. LOD INVESTI GATION MADE X YES NO e. DURATION Applies ONLY to 3. c* and d. DATE YYMMDD HOUR 1 START 2 FINISH 10. BASIS FOR FINDINGS As determined by investigation 2 DATE YYMMDD 3 PLACE a* CIRCUMSTANCES 4 HOW SUSTAINED b. MEDICAL DIAGNOSIS d. IF ABSENT X c* PRESENT FOR DUTY X WITH AUTHORITY Do not complete 10. e. and f* in death cases. e. WAS INTENTIONAL MISCONDUCT OR NEGLECT THE PROXIMATE CAUSE X f* WAS INDIVIDUAL MENTALLY SOUND X g. REMARKS 11. FINDINGS X one. Do not complete in death cases. IN LINE OF DUTY a* TYPED NAME Last First Middle Initial f* SIGNATURE 13. ACTION BY APPOINTING AUTHORITY c* X one. Indicate reasons and substituted findings on back. APPROVED f* BRANCH OF SERVICE a* HEADQUARTERS d. SSN 14. ACTION BY REVIEWING AUTHORITY g. SSN 15. FINAL APPROVAL For action of office indicated in Item 4. SSN 18. GRADE 19. APPOINTING AUTHORITY - REASONS AND SUBSTITUTED FINDINGS 20. REVIEWING AUTHORITY - REASONS AND SUBSTITUTED FINDINGS 21. 1. REPORT DATE YYMMDD REPORT OF INVESTIGATION LINE OF DUTY AND MISCONDUCT STATUS 2. INVESTIGATION OF X one INJURY 3. STATUS X as applicable DISEASE ILLNESS DEATH a* REGULAR OR EAD 4. TO Major Army or Air Force Commander b. STATUS X as applicable DISEASE ILLNESS DEATH a* REGULAR OR EAD 4. TO Major Army or Air Force Commander b. CALLED OR ORDERED TO AD FOR 1 MORE THAN 30 DAYS 2 30 DAYS OR LESS 5. NAME OF INDIVIDUAL Last First Middle Initial 6. CALLED OR ORDERED TO AD FOR 1 MORE THAN 30 DAYS 2 30 DAYS OR LESS 5. NAME OF INDIVIDUAL Last First Middle Initial 6. SSN 7. GRADE c* INACTIVE DUTY TRAINING Type 8. ORGANIZATION AND STATION d. SHORT TOUR OF ACTIVE DUTY FOR TRAINING 9. SSN 7. GRADE c* INACTIVE DUTY TRAINING Type 8. ORGANIZATION AND STATION d. SHORT TOUR OF ACTIVE DUTY FOR TRAINING 9. OTHER MILITARY PERSONNEL INVOLVED IN THE SAME INCIDENT NAME Last First Middle Initial a* SSN b. c* d. OTHER MILITARY PERSONNEL INVOLVED IN THE SAME INCIDENT NAME Last First Middle Initial a* SSN b. c* d. LOD INVESTI GATION MADE X YES NO e. DURATION Applies ONLY to 3. c* and d. DATE YYMMDD HOUR 1 START 2 FINISH 10. LOD INVESTI GATION MADE X YES NO e. DURATION Applies ONLY to 3. c* and d. DATE YYMMDD HOUR 1 START 2 FINISH 10. BASIS FOR FINDINGS As determined by investigation 2 DATE YYMMDD 3 PLACE a* CIRCUMSTANCES 4 HOW SUSTAINED b. BASIS FOR FINDINGS As determined by investigation 2 DATE YYMMDD 3 PLACE a* CIRCUMSTANCES 4 HOW SUSTAINED b. MEDICAL DIAGNOSIS d. IF ABSENT X c* PRESENT FOR DUTY X WITH AUTHORITY Do not complete 10. e. and f* in death cases.

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