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Get DA 5425 2010-2021

Subtract FICA and Income Taxes Subject f. Total After Tax Income Equal g. Any other Monthly Income Do not include Spouse s income Add TOTAL MONTHLY SPENDABLE INCOME ADDITIONAL INFORMATION OR REMARKS DA FORM 5425 SEP 2010 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 3 APD PE v1.00ES 6. APPLICANT/NOMINEE PERSONAL FINANCIAL STATEMENT For use of this form see AR 601-1 the proponent agency is DCS G-1. PRIVACY ACT STATEMENT AUTHORITY 5 U*S*C. 301 Departmental Regulation 10 U*S*C. 3013 Secretary of the Army AR 601-1 Assignment of Enlisted Personnel to the US Army Recruiting Command. PRINCIPAL PURPOSES To verify that the individual meets financial criteria and is suitable for selection and assignment for recruiting duty. This form will be used during inprocessing at the Army Recruiter Course to confirm continued eligibility ROUTINE USES None. The Blanket Routine Uses set forth at the beginning of the Army s Compilations of System of Records Notices apply to this system* DISCLOSURE Voluntary. However failure to provide the requested information may result in selection and assignment made without consideration of your financial status. 1. NAME Last First Middle 2. GRADE 3. Are you now or have you ever filed for bankruptcy If yes state when where and why. YES NO 4. Have you ever received a letter s of indebtedness If yes enter month and year below. MONTH YEAR 5. MONTHLY INCOME AMOUNT TOTAL a* Basic Pay b. Separate Rations c* Clothing Allowance d. Total Military Income Before Taxes Total of a thru c above e. ASSETS a* Do you have a savings account Enter approximate balance b. Do you own stocks bonds or benefit from a trust Enter approximate value c* Do you own with no payments 1 Vehicles MAKE MODEL Enter total estimated value Home Trailer x one 3 Furniture Enter estimated value 4 Land Enter estimated value TOTAL ASSETS 7. MONTHLY EXPENDITURES/LIABILITIES MONTHLY PAYMENT a* Cost of food Include meals eaten out school lunches etc* b. Clothing Dry cleaning/laundry c* Medical Doctor orthodontist special medications special schooling or treatment for handicapped family member d. Insurance Life auto homeowner other e. Vehicle expenses 2 Gas Oil maintenance f* List charge cards or credit cards for which you have an outstanding balance BALANCE OWED NAME g. List finance companies banks credit unions or other institutions where you have an outstanding loan h. Alimony or child support. i. Any allotments for purposes not listed above If yes state for what purpose. j. Any other indebtedness or financial obligation not listed above Use remarks section to explain if necessary. APPLICANT/NOMINEE PERSONAL FINANCIAL STATEMENT For use of this form see AR 601-1 the proponent agency is DCS G-1. PRIVACY ACT STATEMENT AUTHORITY 5 U*S*C. 301 Departmental Regulation 10 U*S*C. 3013 Secretary of the Army AR 601-1 Assignment of Enlisted Personnel to the US Army Recruiting Command. PRIVACY ACT STATEMENT AUTHORITY 5 U*S*C. 301 Departmental Regulation 10 U*S*C. 3013 Secretary of the Army AR 601-1 Assignment of Enlisted Personnel to the US Army Recruiting Command. PRINCIPAL PURPOSES To verify that the individual meets financial criteria and is suitable for selection and assignment for recruiting duty. .

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