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Get DA 2823 2006-2024

DA FORM 2823 NOV 2006 DA FORM 2823 DEC 1998 IS OBSOLETE APD V1. 00 USE THIS PAGE IF NEEDED. IF THIS PAGE IS NOT NEEDED PLEASE PROCEED TO FINAL PAGE OF THIS FORM. SWORN STATEMENT For use of this form see AR 190-45 the proponent agency is PMG. AUTHORITY PRINCIPAL PURPOSE PRIVACY ACT STATEMENT Title 10 USC Section 301 Title 5 USC Section 2951 E.O. 9397 Social Security Number SSN. To document potential criminal activity involving the U.S. Army and to allow Army officials to maintain discipline law and order through investigation of complaints and incidents. SWORN STATEMENT For use of this form see AR 190-45 the proponent agency is PMG* AUTHORITY PRINCIPAL PURPOSE PRIVACY ACT STATEMENT Title 10 USC Section 301 Title 5 USC Section 2951 E*O. 9397 Social Security Number SSN. To document potential criminal activity involving the U*S* Army and to allow Army officials to maintain discipline law and order through investigation of complaints and incidents. ROUTINE USES Information provided may be further disclosed to federal state local and foreign government law enforcement agencies prosecutors courts child protective services victims witnesses the Department of Veterans Affairs and the Office of Personnel Management. Information provided may be used for determinations regarding judicial or non-judicial punishment other administrative disciplinary actions security clearances recruitment retention placement and other personnel actions. DISCLOSURE 1. LOCATION Disclosure of your SSN and other information is voluntary. 2. DATE YYYYMMDD 5. LAST NAME FIRST NAME MIDDLE NAME 3. TIME 6. SSN 4. FILE NUMBER 7. GRADE/STATUS 8. ORGANIZATION OR ADDRESS I 10. EXHIBIT WANT TO MAKE THE FOLLOWING STATEMENT UNDER OATH 11. INITIALS OF PERSON MAKING STATEMENT ADDITIONAL PAGES MUST CONTAIN THE HEADING STATEMENT OF TAKEN AT PAGE 1 OF PAGES DATED THE BOTTOM OF EACH ADDITIONAL PAGE MUST BEAR THE INITIALS OF THE PERSON MAKING THE STATEMENT AND PAGE NUMBER MUST BE INDICATED. STATEMENT OF 9. STATEMENT Continued INITIALS OF PERSON MAKING STATEMENT OF AFFIDAVIT HAVE READ OR HAVE HAD READ TO ME THIS STATEMENT WHICH BEGINS ON PAGE 1 AND ENDS ON PAGE. I FULLY UNDERSTAND THE CONTENTS OF THE ENTIRE STATEMENT MADE BY ME* THE STATEMENT IS TRUE* I HAVE INITIALED ALL CORRECTIONS AND HAVE INITIALED THE BOTTOM OF EACH PAGE CONTAINING THE STATEMENT. I HAVE MADE THIS STATEMENT FREELY WITHOUT HOPE OF BENEFIT OR REWARD WITHOUT THREAT OF PUNISHMENT AND WITHOUT COERCION UNLAWFUL INFLUENCE OR UNLAWFUL INDUCEMENT. Signature of Person Making Statement WITNESSES Subscribed and sworn to before me a person authorized by law to administer oaths this day of at Typed Name of Person Administering Oath Authority To Administer Oaths. 9397 Social Security Number SSN. To document potential criminal activity involving the U*S* Army and to allow Army officials to maintain discipline law and order through investigation of complaints and incidents. ROUTINE USES Information provided may be further disclosed to federal state local and foreign government law enforcement agencies prosecutors courts child protective services victims witnesses the Department of Veterans Affairs and the Office of Personnel Management. .

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