human resources advanced leaders course 42a€¦ · page 19 marriage certificate page 20 assignment...

HUMAN RESOURCES ADVANCED LEADERS COURSE

42ADetermine Entitlements to Military Pay

and Allowances

DTA

December 2019

Pages 1-2 Orders for Special Duty Assignment Pay

Page 3 Revocation Orders for SDAP

Pages 4 Orders for PCS HDP-L

Page 5 DD1351-2 HDP-L

Page 6 Deployment Orders

Pages 7-10 Orders/certificates for Flight Pay

Pages 11-12 Orders for Parachute Duty Assignment Pay

Pages 13-14 Orders for Demolition Duty Assignment Pay

Documents Associated with Pay and Allowances

DTA

Pages 13-14 Orders for Demolition Duty Assignment Pay

Page 15 DA Form 4187 (personnel Action) Authorizationfor Separate Rations.

Pages 16-17 DA Form 1475 (Basic allowance for SubsistenceCertificate)

Pages 18 DA Form 5960 (Authorization to start, Stop or ChangeBasic Allowance for Quarters & VHA)

Page 19 Marriage Certificate

0 Assignment to Family Housing

Page 21 Termination of Family Housing

Page 22 DD Form 1561 (Statement to Substantiate Payment ofFamily Separation Allowance)

I

DEPARTMENT OF THE ARMYHEADQUARTERS, 23RD ARMORED DIVISIONFORT STEWART, GEORGIA 31314

ORDERS 06-121 10 JUNE 20**

SPECIAL DUTY ASSIGNMENT designator is awarded orterminated as indicated terminate hazardous duty as indicated.

BROWN, CHRISTOPHER E. 999-33-8923, SPC, 23RD MED SPT BNFORT STEWART, GA 31314

ACTION: Award SD1AUTHORITY: AR 600-200EFFECTIVE DATE: 1 JUNE 20**

Drill Sergeant Pay

DTA

DISTRIBUTION:(1)-COMMANDER(5)-PSNCO(10)-SOLDIER

CHARLES K. KINGMAJ, AGCADJUTANT GENERAL

/S/

*** FOR INSTRUCTIONAL PURPOSE ONLY ***

ADDITIONAL Instruction: This order terminates any other Specialduty assignment designator that the member may have beenawarded.

1

DEPARTMENT OF THE ARMYHEADQUARTERS,23RD ARMORED DIVISIONFORT STEWART, GEORGIA 31314

ORDERS 08-121 09 AUGUST 20**

BROWN, CHRISTOPHER E. 999-33-8923, SPC, 23RD MED SPT BNFORT STEWART, GA 31314

ACTION: TERMINATE SD1AUTHORITY: AR 600-200EFFECTIVE DATE: 10 JUNE 20**

Drill Sergeant Pay

SPECIAL DUTY ASSIGNMENT designator is awarded orterminated as indicated terminate hazardous duty as indicated

.DTA



/S/


Drill Sergeant PayADDITIONAL Instruction: This order terminates any other Specialduty assignment designator that the member may have beenawarded.

2



Following orders are change as indicated.

Pertaining to: BROWN, CHRISTOPHER E. 999-33-8923, SPC,23rd Med Spt Bn, FORT STEWART, GA 31314.

As reads: Terminate Drill Sergeants Pay (SD1)How Changed: REVOCATION

ACTION: REVOCATIONSo much of: Para 1, ORDER 08-121, Headquarters, 23rdArmored Division and Fort Stewart, GA dtd09 August 20**.

DTA



/S/


How Changed: REVOCATIONAUTHORITY: DODFMR

3

Department of the Army50th Mechanized Infantry Division

Fort Stewart, Georgia 31314

Order # 67-32 1 June 20**

SNORK, JEFF SFC 111-10-4782HHC 1/50 INF Fort Stewart, Georgia 31314

YOU WILL PROCEED ON PERMANENT CHANGE OF STATION AS SHOWN. YOUWILL REPORT ON OR ABOUT 20 November 200**

ASSIGNED TO: UNITED STATES ARMY REPLACEMENT DETACHMENT (W1RB11)Yungson Korea 90001

ADDITIONAL INSTRUCUTIONS:

(A) OFFICIAL TRAVEL ARRANGMENTS PURCHASED THROUGH ACOMMERCIAL TRAVEL OFFICE NOT UNDER CONTRACT TO THEGOVENMENT WILL NOT BE REIMBURSABLE.

(B) YOU ARE AUTHORIZED SHIPMENT OF HOUSE HOLD GOODS ATGOVENMENT EXPENSE. NOT TO EXCEED AUTHORIZED WEIGHT

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GOVENMENT EXPENSE. NOT TO EXCEED AUTHORIZED WEIGHTALLOWANCE.

(C) DEPENDANTS: (NO)(D) YOU WILL SUBMIT A TRAVEL VOUCHER FOR THIS TRAVEL TO THE

CUSTODIAN OF YOUR FINANCE RECORDS WITHIN 5 DAYS AFTERCOMPLETETION OF TRAVEL.

FOR ARMY USE:AUTH: EDAS CY DTD 20**120MDC: 4AE3 PERS CON NO: 6HXA000ENL/REENLB INDIC: NA ASGD TO MGT DSG:FOR THE COMMANDER: CON SPECIALTY: NONE

DISTRIBUTION:SFC SNORK (20) John J. Smith

PSB: EIB (1) PAB (1) JOHN J SMITHFOA (1) LTC, GS

ACoFS, G1/AG

4

15 Nov

16 Nov

16 Nov

15 Nov

16 Nov

AT

AD

MC

TRAVEL VOUCHER OR SUBVOUCHERRead Privacy Act Statement , Penalty Statement , and Instruct ions on back before complet ingform. Use typewriter, ink, or ball point pen. PRESS HARD. DO NOT use pencil. If morespace is needed, cont inue in remarks.

3. FOR D.O. USE ONLY

Electronic Fund Transfer (EFT)

1. PAYMENT

15. ITINERARY

14. HAVE HOUSEHOLD GOODS BEEN SHIPPED?(X one)

2. TYPE OF PAYMENT (X as applicable)

Member/Employee

a. DATE b. PLACE(Home, Of fice, Base, Act ivity, City and

State; City and Country, etc. )

FT STEWART GA PA

c.MEANS/MODE OFTRAVEL

d.REASON

FORSTOP

e.LODGING

COST

f.POC

MILES

ACCOMPANIED

b. RELATIONSHIP c. DATE OF BIRTHOR MARRIAGE

UNACCOMPANIED

8. DAYTIME TELEPHONE NUMBER &AREA CODE

DSN 317-72-2111

9. TRAVEL ORDER NUMBER67-32

12. DEPENDENT(S) (X and complete as applicable)

11. ORGANIZATION AND STATION2ID CAMP CASY KOREA

10. PREVIOUS GOVERNMENT PAYMENTS/ADVANCES

NONE

13. DEPENDENTS' ADDRESS ON RECEIPT OFORDERS (Include Zip Code)

7. ADDRESS.a. NUMBER AND STREETP.O. BOX 50101

b. CITYAPO

4. NAME (Last , First, Middle Init ial) (Print or type)

SNORK, JEFF5. GRADE

SFC/E-7

c. STATEAP

d. ZIP CODE96205

6. SSN111-10-4782

TDY

Other

d. COMPUTATIONS

a. D.O. VOUCHER NUMBER805221

c. PAID BYC DET176TH FINANCE BNCAMP HENRY KOREA

ADSN 5480

a. NAME (Last, First, Middle Init ial)

STUDENT NOTE:

b. SUBVOUCHER NUMBER

Dependent(s)

ARR

DEP

ARR

DEP

ARR

DEP

ARR

DEP

ARR

DEP

SAVANNAH AIRPORT, GA

SEOUL KOREA

CAMP CASEY KOREA

CP

GA

YES NO (Explain in Remarks)

DLA

PCS

11 Sep

Split Disbursement : Amt to Govt Tvl Charge Card $Payment by Check

DTA

17. DURATION OF TDY TRAVEL

18. REIMBURSABLE EXPENSES

28. AMOUNT PAID$232.04

19. GOVERNMENT/DEDUCTIBLE MEALS

(6) Reimbursable Expenses

(7) Total

(8) Less Advance

(9) Amount Ow ed

(10) Amount Due

Except ion to SF 1012 approved by GSA/IRMS 12-91.

21.a. APPROVING OFFICER SIGNATURE

(1) Per Diem

(2) Actual Expense Allow ance

(3) Mileage

(4) Dependent Travel

(5) DLA

a. DATE b. NATURE OF EXPENSE c. AMOUNT d. ALLOWED

b. DATE

a. DATE b. NO. OF MEALS

20.a. CLAIMANT SIGNATURE/ S /

b. DATE**1117

16. POC TRAVEL(X one) OWN/OPERATE PASSENGER

24. COMPUTED BYABC

23. COLLECTION DATA

25. AUDITED BYDEF

26. TRAVEL ORDERPOSTED BY

GHI

27. RECEIVED (Payee Signature and Date or Check No.)

22. ACCOUNTING CLASSIFICATION212*2010 01-401 1442 21P4 S99999 $232.04

$0.00$4.00$5.00

$378.00$4.00$5.00

PLANE TICKETPORTER TIPS (2 BAGS)TRAVELERS CHECKS

11 SEP15 NOV16 NOV

ARR

DEP

ARR

DEP

ARR

DEP

ARR

e. SUMMARY OF PAYMENT

DD FORM 1 351-2 , AUG 1997 (EG) PREVIOUS EDITIONS OF DD FORM 1351-2 AND 1351-1MAY BE USED UNTIL SUPPLY IS EXHAUSTED.

a. DATE b. NO. OF MEALS

12 HOURS OR LESS

MORE THAN 12 HOURSBUT 24 HOURS OR LESS

MORE THAN 24 HOURS

USAPAV1.00

5

DEPARTMENT OF THE ARMYHEADQUARTERS, 23RD ARMORED DIVISION

FORT STEWART, GEORGIA 31314ORDERS 05-017 15 SEP 20**

DEPLOYMENT ASSINGMENT: You will proceed on or about 20 NOV20** to the designatedLocation indicted below. For a period of not less than 365 days.

SNORK JEFF T. 111-10-4782, SFC, 23RD MAINSPT BNFORT STEWART, GA 31314

DTA

All travel will be by government transportation. Commercial travel isnot authorized.You will report to the Theater Finance Office upon arrival to startyour entitlements.You will complete a travel voucher within five days of returning fromthis assignment.


MICHAEL C. COLTLTC, AGCADJUTANT GENERAL

Michael C. Colt


LOCATION: IRAQ

6


ORDERS 12-17 09 DEC 20**

You will perform or terminate hazardous duty as indicated.

DAVIDSON, PAUL E. 000-33-7777, SGT, 23RD MED SPT BNFORT STEWART, GA 31314

ACTION: PERFORMAUTHORITY: DODFMR and AR 37-104-3TYPE DUTY: Flight Pay (Crewmember)Additional pay code: 1Special qualification identifier awarded: NAEFFECTIVE DATE: 1 DEC 20**

DTA



/S/


Special qualification identifier awarded: NAEFFECTIVE DATE: 1 DEC 20**Date additional pay terminate: NAFormat: 332

7


ORDERS 06-121 12 JUNE 20**


DEREK, BO E. 999-33-8923, SPC, 23RD MED SPT BNFORT STEWART, GA 31314

ACTION: PERFORMAUTHORITY: DODFMR and AR 37-104-3TYPE DUTY: Flight Pay (Non-Crewmember)Additional pay code: 1Special qualification identifier awarded: NAEFFECTIVE DATE: 1 JUNE 20**

DTA


CHARLES K. KINGMAJ, AGADJUTANT GENERAL

/S/


Special qualification identifier awarded: NAEFFECTIVE DATE: 1 JUNE 20**Date additional pay terminate: NAFormat: 332

8

DEPARTMENT OF THE ARMYHEADQUARTERS,23RD ARMORED DIVISIONFORT STEWART, GEORGIA 31314



DEREK,BO E. 999-33-8923, SPC, 23RD MED SPT BNFORT STEWART, GA 31314

ACTION: TERMINATEAUTHORITY: DODFMR and AR 37-104-3TYPE DUTY: Flight Pay (Non-Crewmember)Additional pay code: 1Special qualification identifier awarded: NAEFFECTIVE DATE: 31 JULY 20**

DTA



/S/


Special qualification identifier awarded: NAEFFECTIVE DATE: 31 JULY 20**Date additional pay terminate: NAFormat: 332

9


All personnel in an authorized flying status have qualified for flyingduty pay for the month of OCTOBER 20** except the following:

CERTIFICATE

DIAZ, CHRISTOPER E. 999-33-8923 (Non-Crewmember)

JONES, RANDY T. 999-87-9821 (Non-Crewmember)

AAA4C103.1313.0906.DTA


THOMAS L. TURNERCPT, INFAVIATION OFFICER

/S/


10


FORT STEWART, GEORGIA 31314

ORDERS 10-12 02 OCTOBER 20**


BOSTIC, PAUL D. 999-22-4423, PFC, 1/92ND MECH INFFORT STEWART, GA 31314

ACTION: PERFORMAUTHORITY: DODFMR and AR 37-104-3TYPE DUTY: PARACHUTEAdditional pay code: 1Special qualification identifier awarded: NAEFFECTIVE DATE: 2 October 20**

AAA4C103.1313.0906.DTA



/S/


Special qualification identifier awarded: NAEFFECTIVE DATE: 2 October 20**Date additional pay terminate: NAFormat: 332

11


FORT STEWART, GEORGIA 31314

ORDERS 10-12 30 APR 20**


BOSTIC, PAUL D. 999-22-4423, PFC, 1/92ND MECH INFFORT STEWART, GA 31314

ACTION: TERMINATEAUTHORITY: DODFMR and AR 37-104-3TYPE DUTY: PARACHUTEAdditional pay code: 1Special qualification identifier awarded: NAEFFECTIVE DATE 1 MAY 20**

AAA4C103.1313.0906.DTA



/S/


Special qualification identifier awarded: NAEFFECTIVE DATE 1 MAY 20**Date additional pay terminate: NAFormat: 332

12


ORDERS 03-141 21 MARCH 20**


MAXWELL, JAMES P. 999-59-2124, SSG, 1/93rd MECH INFFORT STEWART, GA 31314

ACTION: PERFORMAUTHORITY: DODFMR and AR 37-104-3TYPE DUTY: DEMOLITIONAdditional pay code: 0Special qualification identifier awarded: NAEFFECTIVE DATE: 19 MARCH 20**

AAA4C103.1313.0906.DTA



/S/


EFFECTIVE DATE: 19 MARCH 20**Date additional pay terminate: NAFormat: 332

13


ORDERS 03-141 30 SEPTEMBER 20**


MAXWELL, JAMES P. 999-59-2124, SSG, 1/93rd MECH INFFORT STEWART, GA 31314

ACTION: TERMINATEAUTHORITY: DODFMR and AR 37-104-3TYPE DUTY: DEMOLITIONAdditional pay code: 0Special qualification identifier awarded: NAEFFECTIVE DATE: 1 SEPTEMBER 20**

AAA4C103.1313.0906.DTA



/S/


Special qualification identifier awarded: NAEFFECTIVE DATE: 1 SEPTEMBER 20**Date additional pay terminate: NAFormat: 332

14

PERSONNELACTIONForuseof thisform, seeAR600-8-6andDAPAM600-8-21; theproponent agency isODCSPER.

Reassignment MarriedArmyCouplesReclassificationOfficer CandidateSchool

DATAREQUIREDBYTHEPRIVACYACTOF1974

SECTIONII -DUTYSTATUSCHANGE (AR600-8-6)

ServiceSchool (Enl only)

ROTCorReserveComponent DutyVolunteeringForOverseaService

SECTIONI -PERSONALIDENTIFICATION

7.Theabovesoldier'sdutystatus ischangedfrom

to

effective hours, 19

SECTIONIII -REQUESTFORPERSONNELACTION8.Irequest thefollowingaction:

PROCEDURE

AUTHORITY:PRINCIPALPURPOSE:

DISCLOSURE:

Title5, Section3012; Title10, USC, E.O. 9397.Usedbysoldier inaccordancewithDAPAM600-8-21whenrequestingapersonnelactiononhis/her ownbehalf (SectionIII).

Voluntary.Failuretoprovidesocial securitynumbermayresult inadelayorerror inprocessingof therequest forpersonnelaction.

ROUTINEUSES: Toinitiatetheprocessingof apersonnel actionbeingrequestedbythesoldier.

TYPEOFACTION TYPEOFACTION PROCEDURE

5.GRADEORRANK/PMOS/AOCE-6/SSG

6.SOCIALSECURITYNUMBER999-00-4135

4.NAME (Last,First, MI)PURDUE, CARLOS M.

2.TO (IncludeZIPCode)DAOFT. STEWART, GA 31314

3. FROM (IncludeZIPCode)COMMANDER212 SPR BNFT. STEWART, GA 31314

1. THRU (IncludeZIPCode)PAC1/22ND CAV SQNFT. STEWART, GA 31314

AAA4C103.1313.0906.DTA

Officer CandidateSchoolAsgmt of PerswithExceptionalFamilyMembersIdentif icationCardIdentif icationTagsSeparateRationsLeave-Excess/Advance/OutsideCONUSChangeof Name/SSN/DOBOther (Specify)

11.Icertify that thedutystatuschange (SectionII) or that therequest forpersonnel action (SectionIII) containedherein-

VolunteeringForOverseaServiceRangerTrainingReassignment ExtremeFamilyProblemsExchangeReassignment (Enl only)

AirborneTrainingSpecialForcesTraining/AssignmentOn-the-JobTraining (Enl only)

RetestinginArmyPersonnel Tests9.SIGNATUREOFSOLDIER (Whenrequired)

SECTIONIV-REMARKS (AppliestoSections II, III, andV) (Continueonseparatesheet)

SECTIONV-CERTIFICATION/APPROVAL/DISAPPROVAL

13. SIGNATURE

ISAPPROVED

RECOMMENDAPPROVAL

ISDISAPPROVED

RECOMMENDDISAPPROVAL

DAFORM4187, DEC82 MAYBEUSEDDAFORM 4187, OCT 93

HASBEENVERIFIED

USAPPCV3.00 COPY1

DUE TO MISSION REQUIREMENTS, COMMANDER HAS AUTHORIZED MESSING SEPERATELY.

START SEPERATE RATION: 10 SEP **

10. DATE10 SEP **

12.COMMANDER/AUTHORIZEDREPRESENTATIVESTEVEN A. RHODES, CPT, IN,CDR

14. DATE10 SEP **

14

/s/

/s/

15

D

S

B

D

S

B

D

S

B

B

AE

ML

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

TOTALDAYS

BASIC ALLOWANCE FOR SUBSISTENCE- CERTIFICATION

ORGANIZATION AND STATION

NAME, SOCIAL SECURITY NUMBER, RANK

SUPPLEMENTAL

PRORATED

FORMONTH

STATIONSYMBOL MPO NUMBER

DATE

23rd MP BN, FT STEWART, GA 31314x FEB

20**6348

2 MAR 20**

BONE, SHARON E.999-00-1212

X

X

X

X X

X

X

X

X

X

X 3

5

3

PRORATED

AAA4C103.1313.0906.DTA

D

S

D

S

B

I CERTIFY THAT PURSUANT TO CHAPTER 1, PART THREE, DEPARTMENT OF DEFENSEMILITARY PAY AND ALLOWANCES ENTITLEMENTS MANUAL, THE MEMBERS LISTEDABOVE ARE ENTITLED TO THE PAYMENT OF SUPPLEMENTAL AND OR PRORATEDSUBSISTENCE ALLOWANCE FOR MEALS ON DATES INDICATED.

DATE TYPED NAME & RANK OF APPROVINGAUTHORITY

SIGNATURE OF APPROVINGAUTHORITY

DD FORM 1475

2 MAR 20** MICHAEL D. FLANAGAN, CPT, MP/S/

16

D

S

B

D

S

B

D

S

B

B

AE

ML

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

TOTALDAYS

BASIC ALLOWANCE FOR SUBSISTENCE- CERTIFICATION

ORGANIZATION AND STATION

NAME, SOCIAL SECURITY NUMBER, RANK

SUPPLEMENTAL

PRORATED

FORMONTH

STATIONSYMBOL MPO NUMBER

DATE

23rd MP BN, FT STEWART, GA 31314

x

JAN20**

63482 FEB 20**

SHORTT, GLENN E.999-00-0290

X

X

X

X X

X

X

X

X

X

X 5

6

4

X X

X

X

AAA4C103.1313.0906.DTA

D

S

D

S

B

I CERTIFY THAT PURSUANT TO CHAPTER 1, PART THREE, DEPARTMENT OF DEFENSEMILITARY PAY AND ALLOWANCES ENTITLEMENTS MANUAL, THE MEMBERS LISTEDABOVE ARE ENTITLED TO THE PAYMENT OF SUPPLEMENTAL AND OR PRORATEDSUBSISTENCE ALLOWANCE FOR MEALS ON DATES INDICATED.

DATE TYPED NAME & RANK OF APPROVINGAUTHORITY

SIGNATURE OF APPROVINGAUTHORITY

DD FORM 1475

2 FEB 20** MICHAEL D. FLANAGAN, CPT, MP/S/

17

NAME (Last, First, MI)

PRIVACYACT STATEMENT

AUTHORITY:

PRINCIPLEPURPOSE:

ROUTINEUSE:

DISCLOSUREISVOLUNTARY:

For useof this form, see37-104-3; theproponent agency isASA(FM)

AUTHORIZATIONTOSTART, STOP, ORCHANGEBASICALLOWANCEFORQUARTERS (BAQ),

AND/ORVARIABLEHOUSINGALLOWANCE (VHA)37USC403; PublicLaw 96-343; EO9397.

Tostart, adjust or terminatemilitarymember'sentitlement tobasic allowancefor quarters(BAQ) and/or variablehousingallowance (VHA).

Toadjust member'smilitary payrecord, informationmaybedisclosedtoArmycomponents, suchas USAFAC,majorcommands,andotherArmyinstallations;toother DODcomponents; other federal agenciessuchasIRS,Social SecurityAdministrationandVA, GAO, membersof Congress;Stateandlocalgovernment; USandStatecourts, andvariouslaw enforcement agencies.Social SecurityNumber(SSN)isusedforpositiveidentification.

Nondisclosuremay result innonpayment of BAQand/or VHA. Disclosureofyour SSNis voluntary.However, this formwillnot beprocessedwithout yourSSNbecausetheArmy identifiesyoufor pay purposesby your SSN.

MARTIAL/DEPENDENCYSTATUS

(3)

(4)

(MemberingradeE7and

(2)(1)

DUTYLOCATION (IncludeStation, Name, City,State, andZipCode)

(3)(2)

(4)

(1)

(5)

(6)

c.

a.

d.

b.(seeblocks (1), (2)& (4))

QUARTERSASSIGNMENT/AVAILABILITY

e. DEPENDENTCHILD(seeblocks (4), (5)& (6))

c.b.(seeblocks (1), (2)& (3))

d.

a.

DATE/ACTION(YYMMDD)

9.

GRADESOCIALSECURITYNUMBER

4.

WITHOUTDEPENDENTS

If youcheck "OTHER" above,prepareDDForm137toestablishdependency.

If childsupport receivedfromanother militerymember, complete(1),(2)&(3).

DEPENDENTS/SHARERS (Continueonbackif required)

BAQTYPE

WITHDEPENDENTS PARTIAL

TRANSIENT(seeblock (3))

ADEQUATE(seeblock (1))

INADEQUATE

NOTAVAILABLE

QUARTERSNO.

FAIRRENTALVALUE$

Spouse/FormerSpouseSSN

Child inCustodyof:

START

CORRECT

CANCEL

STOP

CHANGE

RECERTIFICATION

REPORT

DIVORCED(seeblocks (1), (2)& (3))

SINGLE MARRIED

LEGALLYSEPARATED(seeblocks (1), (2)& (3))

Member Spouse Former Spouse Other

Spouse/FormerSpouseDutyStation

Dateof Marriage,Divorce/Separation

7.

8.

10.

COMMANDERDETERMINATION

MEMBERELECTION

6.5.

1/16TH FAFT BRAGG NC 28307

2.301-30-1301

TYPEOFACTION

3.SSG

FROM: TO:

1.ROSE, PETE

**1215

AAA4C103.1313.0906.DTA

I certify ALLinformationregardingthisauthorizationis correct. I will immediatelynotify theFAO/HROof anychangesintheinformationabove,duetodivorce, marriage, death, livingingovernment quarters etc, whichcouldaffect byBAQor VHAentitlement.IMPORTANT: Makingafalsestatement orclaimagainst theUSGovernment ispunishablebycourts-martial.Thepenalty for willfully makingafalseclaimorafalsestatement inconnectionwithclaimsis amaximumfineof$10,000or imprisonment for 5years, or both.

DATE15.

/ S /

DATE13.

PETE ROSE

Landlord's NameandAddress:Rental/Residential Address:

(3)(2)

(4)

(2)

c.b.a.

(1)

(2)

(3)

MEMBER'SSIGNATURE

EXPENSES, IFAUTHORIZED, I AMREQUESTINGVHABASEDON

DEPENDENTS/SHARERS (Continueonbackif required)

CERTIFICATIONOFDEPENDENTSUPPORT

I certify that I provide,or amwill toprovideadequatesupport for theabovenameddependents.I amawarethat failuretosupport theabovenameddependentsmay result instoppingBAQandrecoupingBAQfor anyprior periods/nonsupport.

IAWserviceregulations, Icertify that thedependency statusof myprimarydependents, onwhosebehalf IamreceivingBAQ, has not changedsoastoaffect my entitlement theretofor theperiod

CERTIFYINGOFFICER'SSIGNATURE

Sharer/LeaseInformation

EffectiveDate: ExpirationDate: Landlord'sPhoneNo.

Numberof Sharers (show name(s)andaddressinblock 10.)

My permanent dutystation: My dependent'slocation: Bothmy permanent dutystationanddependent's location.

DOBOFCHILDREN

DependentMember

TOTALS

MonthlyExpenses:

Mortgage (PITI) or Rent

Insurance

Other

RELATIONSHIPCOMPLETECURRENTADDRESS (IncludeZIPCode)NAMEOFDEPENDENT/SHARER

10.

12.

11.

AddressInformation

ALIICIA ROSE 4040 SQUARE DR

FAYETTEVILLE, NC 28314

SPOUSE

16.

DEC**

(1)PO BOX 1010FAYETTEVILLE NC 28314

12DEC** 12NOV** 910-425-2500$500.00

$500.00 (1)4040 SQUARE DRFAYETTEVILLE NC 28314

14.

17DEC**

DAFORM5960, SEP90 REPLACESDAFORM 3298, JUL80ANDDAFORM 5545, JUL86 WHICHAREOBSOLETE USAPPC V2.00

18

MARRIAGE CERTIFICATESTATE OF GEORGIACOUNTY OF COBB

GROOM: PETE ROSE

BRIDE: ALIICIA H. MONTAGO

THE ABOVE NAMED INDIVIDUALS WERE MARRIED BY ME IN HOLY

AAA4C103.1313.0906.DTA19

MATRIMONY ON THE 15TH DAY OF DECEMBER 20**

Gerald L. PittmanGERALD PITTMAN

JUSTICE OF THE PEACE

FOR INSTRUCTIONAL PURPOSES ONLY

OFFICE SYMBOL ASSIGNMENT/TERMINATION TOFAMILY HOUSING

TO: SEE DISTRIBUTION FROM: HOUSING OFFICE DATE:FT STEWART GA

1. THE FOLLOWING INDIVIDUAL IS ASSIGNED/TERMINATED GOVERNMENT FAMILYQUARTERS:

2 OCT 20**

NAME: PAUL, RAYMOND J.RANK: SSGSSAN: 999-78-2453UNIT: 23RD MI BNASSIGNED: ADEQUATE FAMILY HOUSINGADDRESS: 1099 DRUM DR.

FT STEWART, GA 31314

ASSIGNMENT TO FAMILY HOUSINGATSG-TD-EFS

AAA4C103.1313.0906.DTA

2. EFFECTIVE DATE:

3. AUTHORITY: AR 210-50

4. THIS MOVE IS FOR THE CONVENIENCE OF: GOVERNMENT/ INDIVIDUAL/ COMMAND

5. THIS ACTION IS/ IS NOT TAKEN AS PART OF INTRAPOST MOVE.

FOR THECOMMANDER:

FLORENCE E LEGGETTC: FAM HSG MGT BR

/S/

DISTRIBUTION:INDIVIDUAL 05TRANSPORTATION 05FINANCE OFFICE 02UNIT 01FILE COPY 01


8 OCTOBER 20**

** FOR INSTRUCTIONAL PURPOSE ONLY **

20

OFFICE SYMBOL ASSIGNMENT/TERMINATION TOFAMILY HOUSING

TO: SEE DISTRIBUTION FROM: HOUSING OFFICE DATE:FT STEWART GA

1. THE FOLLOWING INDIVIDUAL IS ASSIGNED/TERMINATED GOVERNMENT FAMILYQUARTERS:

22 OCT 20**

NAME: DOUGLAS, JAMES P.RANK: SFCSSAN: 999-72-3188UNIT: 23RD DIV BANDTERMINATION: ADEQUATE FAMILY HOUSINGADDRESS: 1097 DRUM DR.


TERMINATION OF FAMILY HOUSINGATSG-TD-EFS

AAA4C103.1313.0906.DTA

2. EFFECTIVE DATE:

3. AUTHORITY: AR 210-50

4. THIS MOVE IS FOR THE CONVENIENCE OF: GOVERNMENT/ INDIVIDUAL/ COMMAND

5. THIS ACTION IS/ IS NOT TAKEN AS PART OF INTRAPOST MOVE.

FOR THECOMMANDER:

FLORENCE E LEGGETTC: FAM HSG MGT BR

/S/

DISTRIBUTION:INDIVIDUAL 05TRANSPORTATION 05FINANCE OFFICE 02UNIT 01FILE COPY 01


29 OCTOBER 20**

** FOR INSTRUCTIONAL PURPOSE ONLY **

21

S T A T E M E N T T O S U B S T A N T I A T E P A Y M E N T O F F A M I L Y S E P A R A T I O N A L L O W A N C E

D A T A R E Q U IR E D B Y T H E P R I V A C Y A C T O F 1 9 7 4A U T H O R I T Y :P R I N C I P A L P U R P O S E :R O U T IN E U S E S :

D I S C L O S U R E :

T i t l e 3 7 , U . S . C o d e , S e c t i o n 4 2 7 .T o e v a l u a t e m e m b e r' s a p p l i c a t io n f o r F a m i ly S e p a r a t i o n A l l o w a n c e s .a . S e r v e s a s s u b s t a n t i a t i n g d o c u m e n t f o r F S A p a y m e n t s .b . P r o v i d e s a n a u d i t t r a i l f o r v a l i d a t in g p r o p r i e t y o f p a y m e n t s a n d t o a s s is t i n c o l l e c t i o n e r r o n e o u s p a y m e n t s .c . P r o v i d e s a r e c o r d in s e rv i c e m e m b e r ' s p e r s o n a l f in a n c ia l r e c o r d .d . P r o v i d e s i n f o r m a t io n f o r p r e p a r a t i o n o f r e q u i re d i n p u t t o t h e a u t o m a t e d p a y s y s t e m w h i c h m a i n t a i n s p a ya c c o u n t s f o r A r m y m e m b e r s .D i s c l o s u r e o f y o u r s o c i a l s e c u ri t y n u m b e r a n d o t h e r p e rs o n a l i n f o r m a t i o n i s v o lu n t a r y . H o w e v e r , i f r e q u e s t e di n f o r m a t i o n i s n o t p r o v id e d , m e m b e r m a y n o t b e c o n s id e r e d f o r F S A .

N A M E O F M EM B E RW I L L I A M S , R O N N I E

S O C I A L S E C U R I T Y N U M B E R6 6 6 - 5 5 - 4 4 3 3

G R A D ES G T

O R G A N IZ A T I O N / A C T I V I T YH H C T S B

P E R M A N EN T D U T Y S T A T I O N O F M E M B E R1 0 T H S F G M T P a g , I T A L Y

P A R T I - T O B E C O M PL E T ED B Y T H E M E M B E R ( C h e c k a p p l ic a b l e b l o c k (s ) )

T Y P E I T Y P E I IF S A - 1 F S A - R F S A - T F S A - S

T h e f o l l o w i n g in f o r m a t i o n i s f u r n i s h e d t o su b s t a n t i a t e m y e n t i t le m e n t t o f a m i ly s e p a ra t i o n a l l o w a n c e a s i n d i c a t e d a b o v e .A D D R E S S (e s ) O F D E PE N D E N T ( s ) ( A p p l i c a b l e t o a l l t y p e s o f A l l o w a n c e s ) ( C o n t i n u e o n re v e r se i f n e c e ss a r y )6 2 3 O A K S T . H I N E S V I L L E , G A 3 1 3 1 5

I F C L A I M I N G F S A T Y P E II F O R P A R E N T ( s ) , I C E R T IF Y T H A T :I m a i n t a i n a r e si d e n c e ( s ) f o r m y d e p e n d e n t ( s ) a n d h a v e a s s u m e d t h e l i a b i l i t y a n d r e s p o n s i b il i t i e s t h e r e o f , a t t h e a d d r e s s( e s )s h o w n a b o v e , w h e r e I w il l l ik e l y r e s i d e d u ri n g p e r i o d o f le a v e o r s u c h o t h e r t i m e s a s m y d u t y a s s ig n m e n t m i g h t p e r m i t .

I C E R T I F Y T O T H E F O L L O W I N G F A C T S ( A s a p p l i c a b l e )

I a m n o t d i v o r c e d o r l e g a l l y se p a r a t e d f r o m m y sp o u s e .M y d e p e n d e n t c h i ld ( c h i l d r e n ) a re n o t i n t h e l e g a l c u s t o d y o f a n o t h e r p e r s o n .M y d e p e n d e n t is n o t a m e m b e r o f t h e m il i t a r y s e r v ic e o n a c t i v e d u t y .M y s o l e d e p e n d e n t i s n o t i n a n i n s t i t u t io n f o r a k n o w n p e r i o d o f o v e r 1 y e a r o r a p e ri o d e x p e c t e d t o e x c e e d 1 y e a r .

I a g r e e t o n o t i f y m y c o m m a n d i n g o f f i c e r p r o m p t ly o f a n y c h a n g e i n d e p e n d e n c y s t a t u s i f m y s o l e d e p e n d e n t o r a ll o f m yd e p e n d e n t s m o v e t o t h e a r e a o f t h is s t a t i o n o r i f m y d e p e n d e n t ( s ) v i s i t a t t h i s s t a t i o n f o r m o r e t h a n t h r e e m o n t h s ( 3 0 d a y si n t h e c a se o f ( F A S - S ) ( F A S - T ) w h i l e I a m i n r e c e i p t o f f a m il y se p a ra t i o n a ll o w a n c e .

F U R N IS H T EM P O R A R Y D U T Y I N F O R M A T I O N B E L O W F O R F S A - R A N D F S A - TT E M P O R A R Y D U T Y S T A T I O N ( s )N A

I N C L U S I V E D A T E S ( F r o m / T o )N A

D A T E1 0 S E P * *

S I G N A T U R E O F M EM B E RRonnie Williams

AAA4C103.1313.0906.DTA22

1 0 S E P * *

P A R T I I - T O B E C O M P L E T E D B Y C E R T I F Y I N G O F FI C E R ( C h e c k a p p l ic a b l e b l o c k (s ) )

T Y P E I - FS A - 1 T h e a b o v e m e m b e r re p o r t e d t o 1 0 S F G M T P a g , I T A L Y( D u t y S t a t i o n )

o n 3 1 A U G * *( D a t e )

, a n d t r a n s p o r t a t i o n o f h i s d e p e n d e n t s i s n o t a u t h o r i z e d a t g o v e r n m e n t e x p e n s e t o t h is s t a t io n o r t o a p l a c e n e a rt h i s s t a t i o n . N o g o v e r n m e n t q u a rt e r s a r e a v a i l a b l e f o r a s s i g n m e n t t o t h e m e m b e r .

T Y P E I I - F S A - R T Y P E I I - F S A - TT h e a b o v e m e m b e r d e p a r t e d ( w a s d e t a c h e d ) f r o m F T S T E W A R T , G A

( L a s t p e r m a n e n t d u t y s t a t i o n )o n 1 0 A U G * *

( D a t e )w a s o n l e a v e e n r o u t e 1 0 - 2 8 A U G * *

( I n c l u si v e d a t e s c h a r g e a b l e a s le a v e )p r o c e e d t i m e 2 9 - 3 0 A U G * *

( I n c l u si v e d a t e s )a n d h e r e p o r t e d t o 1 0 T H S F G M T P a g , I T A L Y

( P e r m a n e n t d u t y s t a t i o n )o n 3 1 A U G * *

( D a t e ). T r a n s p o r t a t i o n o f h i s

d e p e n d e n t s i s n o t a u t h o r i z e d a t g o v e r n m e n t e x p e n s e t o t h is s t a t io n o r t o a p l a c e n e a r t h i s st a t i o n .T Y P E I I - F S A - T T h e a b o v e m e m b e r h a s b e e n o rd e r e d t o a n d h a s p e r f o r m e d t e m p o r a r y d u t y a t t h e l o c a t i o n ( s ) s h o w n b e l o w f o r a

c o n t i n u o u s p e r i o d o f m o r e t h a n 3 0 d a y s .L O C A T I O N I N C L U S I V E D A T E S O F T D Y / T ( F r o m / T o ) N O . D A Y S

N O T E : C o n t i n u e o n re v e r se i f n e c e ss a r y .

T Y P E I I - F S A - SM e m b e r w a s o n d u t y o n b o a r d sh i p u p o n d e p a r t u r e f r o m h o m e p o r t o n .

( D a t e )M e m b e r d i d n o t d e p a r t w i t h s h i p b u t r e p o r t e d o n b o a r d ( o r r e j o i n e d ) t h e sh i p a t

. ( L o c a t i o n )o n

N A M E O F S H I P L O C A T IO N O F H O M E P O R T

T r a v e l p e r f o r m e d u n d e r a u t h o r i t y o f O r d e r # 1 2 2 - 3 4 2 3 D I N F D IV F S G A D a t e d 2 9 M A Y * *

M e m b e r c l a i m i n g T y p e I I F S A , i s r e c e i v in g b a s i c a l l o w a n c e f o r q u a r t e rs a s a m e m b e r w i t h d e p e n d e n t s .

D A T E1 0 S E P * *

S I G N A T U R E O F C E R T I FY I N G O F F I C E R

D D F o r m 1 5 6 1 , A P R 7 7 ( E G ) P R E V I O U S E D I T IO N I S O B S O L E T E W H S / D IO R , O c t 9 8

/s/

Ronnie Williams

DA 2142

DA 7003

Page 26 Reserve Units and UIC’s

Page 27 Information Sheet

Page 28 Information Sheet

Page 29 DA Form 4187 (Name Change)

Page 30 DA Form 4187 (Reduction in Grade)

Page 31 DA Form 362 Report of Survey

DOCUMENTS ASSOCIATED WITHRESERVE PAY

AAA4C103.1313.0906.DTA

Page 31 DA Form 362 Report of Survey

Page 32 DA 7003

Page 33 SGLV-8286 (Servicemen’s Group Life InsuranceElection and Certificate)

Page 34 W-4 Form

Page 35 Drill Attendance Roster

Page 36 Reserve Orders (Long Tour)

Page 37 Reserve Orders (Short Tour)

23

PAY INQUIRYFor use of this form see AR 37-104-3; the proponent agency is USAFAC.

1.

SECTION I (To be completed by soldier)

SECTION II (To be completed by Unit Commander)

Supporting document(s) submitted or will be submit ted to f inance.

2. Local payment. Soldier has been counseled regarding impact on future pay. My recommendation is to approve/disapprove (cross out theappropriate word) the local payment.

3. Other (Specify)

BLOCK NUMBER

INQUIRY NO.01

DATE19 SEPT XX

NAME (Last, First, Middle)PARSNIP, REGINALD W.

SSN999-99-1000

GRADEE-7

UNIT1/15TH ARMOR FT. STEWART, GA 31313

x0011NATURE OF PAY INQUIRY (Be specif ic)

SOLDIER REQUESTS CASUAL PAYMENT DUE TO A FAMILY EMERGENCY.

SOLDIER IS REQUESTING FUNDS TO OFFSET UNEXPECTED EXPENSES.

DATE TL NUMBER

PHONE NUMBER

XXXXXX

AAA4C103.1313.0906.DTA

3. Other (Specify)

Signature of Unit Commander (or soldier as appropriate).

SECTION III (To be completed by Finance)

PROBLEMAllotment

Non-receipt Check

Entit lements

Non-receipt LES

Collection

Other (Specify)

Leave

INQUIRY ANALYSIS CAUSE

1.

3.

5.

7.

Non-receipt of document from Unit Commander.

Document received - Finance did not process.

Document received from Unit Commander on time

USAFACbut too late to be processed prior to JUMPS cutoff.

2.

4.

6.

8.

Late receipt of document from Unit Commander.

Document received and processed but rejected on DJUOL.

Problem with prior stat ion.

Other (Specify)

ACTION REQUIRED

DA Form 3684Other (Specify)

Local Payment INQUIRY EVALUATION

Valid Invalid

SIGNATURE OF PAY CLERK

DATE19 SEPT XX

DESCRIPTION OF CAUSE AND ACTION TAKEN.

PAID SOLDIER LOCAL PAYMENT IN THE AMOUNT OF ____________.

STUDENT NOTE: DOV # IS 600165

DATE APPROVED LOCAL PAYMENT PAID19 SEPT XX

DA FORM 21 42, APR 82 EDITION OF 1 APR 73 WILL BE USED UNTIL EXHAUSTED USAPPC V1.00PFR

LOCAL PAYMENT

SPC MARLBORO

BRUCE HEATH, CPT, AR, COMMANDING

24

1. TYPE OF PAYMENT (Check one)

PA (ADVANCE) PM (BONUS/RRB)

X PC (CASUAL) PQ (SEPARATE)

PJ (CONT/PAY) PQ (REENLIST)

PX (PARTIAL) OTHER (LISTTYPE)

PL (BONUS/SRB)

2. SOCIAL SECURITY NO

4. PERMANENT PARTY STATION ADDRESS

PAYMENT AUTHORIZATION(JUMPS)For use of this form see AR 37-014-3; the proponent agency is ASA (FM)

3. NAME (Last, First, Middle)

PAID BY

10. VOUCHER DATE (YYMMDD)

11. AGENCY CODE

5. SPECIAL PAYMENT INSTRUCTIONS

7. CHECK ADDRESS ( if applicable)

12. VOUCHER NUMBER

13. AMOUNT PAID

6. MEMBER CERTIFICATION (Check appropriate item)

I have received _______previous casual payments

during this reassignment, TDY, or authorized leave

under Order No.__________.To the best of my knowledge, all payments I have

received have been deducted from my pay account

and all leave I have taken has been posted against

my leave balance. I understand that the final payment

made to me on my separation form active service may

be adjusted by central site. This adjustment would be

based on a detailed computation of all valid transactions

999-99-1000 PARSNIP, REGINALD

HHC, 1/15th ARMOUR DIVFT STEWART GA 31313

23rd FBFT STEWART GA, 31413ADSN 6348

19 SEP **

**0922

ARMY

600500

$395.00 /I/

XX

AAA4C103.1313.0906.DTA

8. PCS ACTIONS

PAYMENT POSTED TO DA FORM 2356

MEMBER NOT IN POSSESSION OF PCS PACKAGE

17. PREPARED BY (Signature/Date) RECEIPT OF AMOUNT SHOWN PAID IS ACKNOWLEDGED

18. SIGNATURE OF PAYEE 19. DATE 20. APPROVED BY (Signature/Date)

16. PAYROLL NUMBER

15b NUMBER OF MONTHS REPAYMENT

15a NUMBER OF MONTHS ADVANCE

14 CLEAR ACCOUNT ID (Check one)

15. ADVANCE PAY CATEGORY (if applicable)

OFFICER ENLISTED

9. REMARKS


affecting my pay account. I have also been informed

that my final leave and earnings statement will show

any adjustments that are known on my computation date.

DA FORM 7003, JUL 91

x

LOCAL PYMT FOR EMERGENCYREASONS.

21*2010 01-1100 P1190.00 1199 S99999

/ S / /S/**0919 Reginald Parsnip FOR:Walter C. Cory,LTC, FC

19SEP**

For Instructional Purposes Only

25

RESERVE UNITS AND UIC'S

UNIT UIC

1ST BDE AEJAAA

4-77 MECH AEJMEA

4-2 ARMOR AEJDAA

4-3 ARMOR AEJEAA

2ND BDE SNAAAA

4-78 MECH SNAFEA

4-79 MECH SNAHBA

4-4 ARMOR SNABAE

1-23 ARMOR SNABBD

AAA4C103.1313.0906.DTA

FT. Stewart, GA site ID is “L5”.

26

INFORMATION ON SOLDIERS IN THE 55TH INFANTRY DIVISION

NAME SSN GRADE UNIT INCENTIVE PAY

JONES, TIMOTHY 888-74-0102 E-1 4/2 ARMOR NONE

LEONARD, SAM 888-74-0110 E-2 HHC, 1ST BDE Para Req met

CARTER, LARRY 888-74-0117 E-3 4/77 MECH INF NONE

BUNDELL, RONALD 888-74-0124 E-4 4/79 MECH INF Para Req met

FLINT, BARNEY 888-72-1131 E-5 4/79 MECH INF Para Req met

JUNE, FRANK 888-74-1238 E-6 HHC, 2ND BDE NONE

RILEY, JOHN 888-67-1245 E-7 4/3 ARMOR NONE

LITTLE, CARL 888-69-1251 E-8 4/4 ARMOR Demo Req met

HARRIS CHARLIE 888-71-1359 E-3 HHC, 2ND BDE NONE

PERRON, DANIEL 888-73-2366 O-1 4/78 MECH INF NONE

AAA4C103.1313.0906.DTA

STONE, MICHAEL 888-70-2473 O-2 4/77 MECH INF NONE

27

INFORMATION ON FINANCE SPECIALIST COURSE, FINANCE SCHOOL, FORTJACKSON, SOUTH CAROLINA.

A. 1 DAY TRAVEL AUTHORIZED EACH WAY.

B. NO BAS AUTHORIZED.

INFORMATION ON WEEKEND DRILL PAY.

A. 0 TRAVEL DAYS AUTHORIZED.

B. RNA IS AUTHORIZED.

C. NO INCENTIVE PAY IS AUTHORIZED.

INFORMATION ON AIR ASSAULT COURSE, FORT CAMPBELL, KENTUCKY.

A. 2 TRAVEL DAYS AUTHORIZED EACH WAY.

B. NO BAS IS AUTHORIZED.

AAA4C103.1313.0906.DTA

C. INCENTIVE PAY AUTHORIZED - PARA, REQUIREMENTS MET.

D. 200 MILES ONE WAY

** ASSUME CERTIFICATE OF COMPLETION IS ATTACHED.

** NO C02 WILL BE INPUT ON ANY OF THE INPUTS.

** NO TRAVEL DAYS AUTHORIZED FOR DEPLOYMENTS FROM FTJACKSON.

28

PERSONNELACTIONForuseof thisform, seeAR600-8-6andDAPAM600-8-21; theproponent agency is ODCSPER.



SECTIONII -DUTYSTATUS CHANGE (AR600-8-6)





to

effective hours, 19


PROCEDURE


DISCLOSURE:

Title5, Section3012; Title10, USC, E.O. 9397.Usedbysoldier inaccordancewithDAPAM600-8-21whenrequestingapersonnel actiononhis/her ownbehalf (SectionIII).

Voluntary.Failuretoprovidesocial securitynumbermayresult inadelayorerror inprocessingof therequest forpersonnel action.



5.GRADEORRANK/PMOS/AOCSFC / E-7


4.NAME (Last,First, MI)RILEY, JOHN

2.TO (IncludeZIPCode)DAO23RD FIN BNATTN: RESERVE PAYFT STEWART, GA 31314

3. FROM (IncludeZIPCode)COMMANDER4/3 ARMORHINESVILLE GA 31314

1. THRU (IncludeZIPCode)

AAA4C103.1313.0906.DTA

Officer CandidateSchoolAsgmt of PerswithExceptional FamilyMembersIdentif icationCardIdentif icationTagsSeparateRationsLeave-Excess/Advance/OutsideCONUSChangeof Name/SSN/DOBOther (Specify)

11.Icertify that theduty status change (SectionII) or that therequest forpersonnel action (SectionIII) containedherein-

VolunteeringForOverseaServiceRangerTrainingReassignment ExtremeFamily ProblemsExchangeReassignment (Enl only)

AirborneTrainingSpecial ForcesTraining/AssignmentOn-the-JobTraining (Enl only)




13. SIGNATURE

ISAPPROVED

RECOMMENDAPPROVAL

ISDISAPPROVED



HASBEENVERIFIED

USAPPCV3.00 COPY1

SOLDIER NAME IS INCORRECT ON HIS RECORDS. CHANGE TO JOHNNY RILEY.

10. DATE

12.COMMANDER/AUTHORIZEDREPRESENTATIVET. J. ROWE, CP T, FC, CDR

14. DATE24 SEP **

CHANGE NAME

JOHN RILEY23 MAY **

X

T. J. ROWE

29

PERSONNELACTIONForuseof thisform, seeAR600-8-6andDAPAM600-8-21; theproponent agency is ODCSPER.



SECTIONII -DUTYSTATUS CHANGE (AR600-8-6)





to

effective hours, 19


PROCEDURE


DISCLOSURE:

Title5, Section3012; Title10, USC, E.O. 9397.Usedbysoldier inaccordancewithDAPAM600-8-21whenrequestingapersonnel actiononhis/her ownbehalf (SectionIII).

Voluntary.Failuretoprovidesocial securitynumbermayresult inadelayorerror inprocessingof therequest forpersonnel action.



5.GRADEORRANK/PMOS/AOCSPC / E-4


4.NAME (Last,First, MI)BUNDELL, RONALD

2.TO (IncludeZIPCode)DAO23RD FIN BNATTN: RESERVE PAYFT STEWART, GA 31314

3. FROM (IncludeZIPCode)COMMANDER4/79TH INFGARDEN CITY, GA 31418

1. THRU (IncludeZIPCode)

AAA4C103.1313.0906.DTA

Officer CandidateSchoolAsgmt of PerswithExceptional FamilyMembersIdentif icationCardIdentif icationTagsSeparateRationsLeave-Excess/Advance/OutsideCONUSChangeof Name/SSN/DOBOther (Specify)

11.Icertify that theduty status change (SectionII) or that therequest forpersonnel action (SectionIII) containedherein-

VolunteeringForOverseaServiceRangerTrainingReassignment ExtremeFamily ProblemsExchangeReassignment (Enl only)

AirborneTrainingSpecial ForcesTraining/AssignmentOn-the-JobTraining (Enl only)




13. SIGNATURE

ISAPPROVED

RECOMMENDAPPROVAL

ISDISAPPROVED



HASBEENVERIFIED

USAPPCV3.00 COPY1

THE ABOVE NAMED INDIVIDUAL IS REDUCED FROM THE GRADE OF E-4 TO E-3, EFFECTIVE1 SEP **.

10. DATEREDUCTION

12.COMMANDER/AUTHORIZEDREPRESENTATIVET. J. ROWE, CP T, FC, CDR

14. DATE2 SEP **

X

T. J. ROWE

30

STATEMENT OFCHARGES/CASHCOLLECTIONVOUCHER

VOUCHERNUMBER

STOCKNUMBERa.

ITEMDESCRIPTIONb.

QTYc.

UNITPRICEd.

TOTALCOSTe.

1.DATE30 SEP *

2.DOCUMENT/VOUCHERNUMBER

3.ORGANIZATIONCIF

4.STATION4-79MECH INF GARDEN CITY, GA 31418

5.DISBURSINGOFFICECOLLECTION 6.DISBURSINGSTATIONSYMBOLNUMBER

6348

7.ACCOUNTINGCLASSIFICATION

125-09236

4240-012580062

AMMO POUCHES

CHEMICAL BIOLOGICAL MASK FIELD M40

2

1

7.55

240.00

15.10

240.00

AAA4C103.1313.0906.DTA

11.DISBURSINGOFFICERORPAYROLLCERTIFYINGOFFICERTheamount enteredingrandtotal has been(FAO)check theappropriateactionbelow.

8.TYPEORACTION (Select one)

a.PAYROLLDEDUCTION b.CASHCOLLECTION

255.10

9.CERTIFICATIONOFRESPONSIBLEINDIVIDUALIcert ifythat mysignaturehereonconstitutesa.

b.c.

Anauthorizationtorecover theamount of theindebtedness throughpayroll deduction, if payroll deductionis checked. If cashcollectionischecked,Iamremittingdebt incash.Anaffirmationthat thearticles arenot nowinmypossession.Anagreement toturn-intotheappropriatesupplyofficerall articleslater recovered, it beingunderstoodthat theU.S.Governmentretains titletothearticleslistedhereon.

GRADE CHARGEh. SIGNATURE

10.ORGANIZATIONCOMMANDER

Thestatements hereonare completeandcorrect. All damaged property hasbeendisposedof inaccordancewithcurrent directives andthe charges havebeencomputedinaccordancewiththeprovisionsof AR735-5, Appendix B. a. Enteredontheappropriatepayrecordor payroll,or DDForm139

hasbeenpreparedandforwardedfor collect ion.

b. Remittedthroughcashcollection.

b.SIGNATUREBLOCK/SIGNATURE d.SIGNATUREBLOCK/SIGNATURE

USAPPCV1.00Previous editionmaybeused.DDFORM 362, JUL93

c.GRANDTOTAL

255.10

d.RANK/

SPC

e.NAME (LAST,First, MiddleInitial)BUNDELL, RONALD

f.SOCIALSECURITYNUMBER888-74-0124

g. CAUSEFOR

LOST

i.AMOUNT

255.10

a. DATE

30 MAY **

c.DATE

30 SEP *

RICHARD W. TOWNSEND

J.D. REED

J.D. REED53RD FAFT STEWART,GA

JOHN H. LEWIS

JOHN H. LEWISLTC, FCDAO

31

X

1. TYPE OF PAYMENT (Check one)

PA (ADVANCE) PM (BONUS/RRB)

PC (CASUAL) PQ (SEPARATE)

PJ (CONT/PAY) PQ (REENLIST)

PX (PARTIAL) OTHER (LISTTYPE)

PL (BONUS/SRB)

2. SOCIAL SECURITY NO

4. PERMANENT PARTY STATION ADDRESS

PAYMENT AUTHORIZATION (JUMPS)For use of this form see AR 37-014-3; the proponent agency is ASA (FM)

3. NAME (Last, First, Middle)

PAID BY

10. VOUCHER DATE (YYMMDD)

11. AGENCY CODE

5. SPECIAL PAYMENT INSTRUCTIONS

7. CHECK ADDRESS ( if applicable)

12. VOUCHER NUMBER

13. AMOUNT PAID

6. MEMBER CERTIFICATION (Check appropriate item)

I have received _______previous casual payments

during this reassignment, TDY, or authorized leave

under Order No.__________.To the best of my knowledge, all payments I have

received have been deducted from my pay account

and all leave I have taken has been posted against

my leave balance. I understand that the final payment

made to me on my separation form active service may

be adjusted by central site. This adjustment would be


888-74-0124 BUNDELL, RONALD

23RD FBFT STEWART GA, 31414

ADSN 634822 SEP **A CO 1-23RD ARMOR, FT STEWART GA 31414

**0922

ARMY

650123

$150.00

xx

ARMY RESERVISTINPUT REQUIRED FORRCIS

AAA4C103.1313.0906.DTA

8. PCS ACTIONS

PAYMENT POSTED TO DA FORM 2356

MEMBER NOT IN POSSESSION OF PCS PACKAGE

17. PREPARED BY (Signature/Date) RECEIPT OF AMOUNT SHOWN PAID IS ACKNOWLEDGED

18. SIGNATURE OF PAYEE 19. DATE 20. APPROVED BY (Signature/Date)

16. PAYROLL NUMBER

15b NUMBER OF MONTHS REPAYMENT

15a NUMBER OF MONTHS ADVANCE

14 CLEAR ACCOUNT ID (Check one)

15. ADVANCE PAY CATEGORY (if applicable)

OFFICER ENLISTED

9. REMARKS


affecting my pay account. I have also been informed

that my final leave and earnings statement will show

any adjustments that are known on my computation date.

DA FORM 7003, JUL 91

X

21*2010 01-1100 P1190.00 1199 S99999

JOE T. CLARKSPC, FINANCE SERVICES Ronald Bundell 21SEP ** Walter C. Cory 21 SEP **

Walter C. CoryLTC,FC,Finance Officer

Joe T. Clark 21 NOV **

32

Servicemembers'GroupLifeInsuranceElectionandCertificateUsethisformto: (checkall that apply)

Name, changeor updateyour beneficiaryReducetheamount of your insurancecoverageDeclineinsurancecoverage

Important: Thisformis for useby ActiveDutyandReservemembers. Thisformdoesnot applytoandcannot beusedfor anyother Government Life Insurance.

Last nameRILEY

First nameJOHN

Middlename Rank, title, or gradeSFC/E-7

Social SecurityNumber888-67-1245

Branchof Service(Donot abbreviate)ARMY

Current DutyLocation4/3 ARMOR , HINESVILLE GA 31314

Amount of Insurance

Bylaw, youareautomatically insuredfor $200,000. If youwant $200,000of insurance, skiptoBeneficiary(ies)andPayment Options. If youwant lessthan$200,000of insurance, pleasechecktheappropriateblockbelow andwritetheamount desiredandyour initials. Coverageis available inthefollowingamounts:$190,000, $180,000, $170,000, $160,000, $150,000, $140,000, $130,000, $120,000,$110,000, $100,000, $90,000, $80,000, $70,000, $60,000, $50,000,$40,000, $30,000, $20,000, $10,000. If youdonot want anyinsurance, checktheappropriateblockbelow andwrite(inyour ownhandwriting), "I donot wantinsuranceat thistime."

I want coverage intheamount of $ 150,000.00 Your init ials JR

(Write"I donot want insuranceat thistime.")Note: Reducedorrefusedinsurancecanberestoredonlybywrittenrequest withproof of goodhealthandcompliancewithotherrequirements.

Beneficiary(ies) andPayment OptionsI designatethefollowingbeneficiary(ies) toreceivepayment of my insuranceproceeds. I understandthat theprincipal beneficiary(ies) will receivepayment uponmydeath. If allprincipal beneficiariespredeceaseme, theinsurancewill bepaidtothecontingent beneficiary(ies).

CompleteName (first, middle, last) andAddressof eachbeneficiary

Social SecurityNumber

(if known)

Relationshiptoyou

Sharetoeachbenef iciary

(Use%, $amountsor fractions)

Payment Option(Lumpsumor 36equal monthly

payments)

Pleasereadtheinstructionsonthebackbeforecompletingthisform.

AAA4C103.1313.0906.DTA

payments)

Principal1.

BERNADETTE RILEY

2.887-34-1905 WIFE 1 LUMP SUM

Contingent1.

NONE

2.

3.

4.

I HAVEREADANDUNDERSTANDtheinstructionsonthefront andbackof thisform. I ALSOUNDERSTANDthat:Thisformcancelsanyprior beneficiaryor payment instructionsTheproceedswillbepaidtobeneficiariesasstatedin#6 ontheback of thisform,unlessotherwisestatedaboveIf I havelegal questionsabout thisform, I may consult withamilitary attorney at noexpensetomeI cannot havecombinedSGLI andVGLIcoveragesat thesametimefor morethan$200,000

SIGNHEREININK Date: 1 SEP**

(Yoursignature. Donot print.)Donot writeinspacebelow- For official useonly.

WITNESSEDANDRECEIVEDBY:

RUDY T. SMITH, ILT, AG

RANK, TITLE, ORGRADE

ASST ADJUTANT

ORGANIZATION

4-79 MECH INF

DATERECEIVED

1 SEP **

SGLV-8286, April 1996 (EG) SupersedesSGLV8286, March1994WhichWill Not BeUsed

LOCALREPRODUCTIONAUTHORIZED

MEMBER'S OFFICIAL PERSONNELFILE 1TOMEMBER(Certificateof Coverage) 2

UNIFORMEDSERVICESCOPY 3

JOHN RILEY

33

Form W-4 (1996) and inclides unearned income (e.g. interest Otherwise, you may find that you oweand dividends) and (2) and another person can additional tax at the end of the year.

Want More Money In Your Paycheck? claim you as a dependent on their tax return. Two Earners/Two Jobs: If you have a workingIf you expect to be able to take the earned Basic instructions: If you are not exempt, spouse or more than one job, figure the total

complete the Personal Allowances Worksheet number of allowances you are entitled toclaimincome credit for 1996 and a child lives with Additional worksheets are on page 2 so you on all jobs using worksheets from only oneyou, you may be able to have part of the credit can adjust your withholding allowances based W-4. This total should be divided among alladded to your take-home pay. For details, get on itemized deductions, adjustments to jobs. Your withholding will usually be mostForm W-5 from your employer. income, or two-earner/two-job situations. accurate when all allowances are claimed on

Complete all worksheets that apply to your the W-4 filed for the highest paying joband zero allowances are claimedfor the others.Purpose. Complete Form W-4 so that your situation. The worksheets will help you figure Check your withholding. After your W-4employer can withhold the correct amount of the number of withholding allowances you are takes effect, use Pub. 919, Is My WithholdingFederal Income tax from your pay. Because entitled to claim. However, you may claim Correct for 1996?, to see how the dollaryour tax situation may change, you may want fewer allowances than this. amount you are having withheld compares toto refigure your withholding each year. Head of Household: Generally, you may claim your estimated total annual tax. Get Pub. 919Exemption from Withholding. Read line 7 of head of household filing status on your tax especially if you used the Two Earner/Two Jobthe certificate below to see if you can claim return only if you are unmarried and pay more Worksheet and your earnings exceed $150,000exempt status. If wxempt only complete lines than 50% of the costs of keeping up a home (Single) or $200,00 (Married). To order Pub.1,2,3,4,7 and sign the form to validate it. for yourself and your dependent(s) or other 919, call 1-800-829-3575. Check yourNo Federal income tax will be withheld from qualifying individuals. telephone directory for the IRS assistanceyour pay. Your exemption expires February 18, Nonwage income: If you have a large amount number for further help.1997. of nonwage income, such as interest or Sign This Form:W-4 is not consideredNote: You cannot claim exemption from dividends, you should consider making valid unless you sign it.

withholding if your income exceeds $550.00 estimated tax payments using Form 1040ES.

Personal Allowances Worksheet

A Enter ‘1’ for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . . . . . A _________

+ You are single and have only one job; or

B Enter ‘1’ if: + You are married, have only one job, and your spouse does not work; or . . . B _________

+ Your wages from a second job or your spouse’s wages (or the total of both ) are $1,000 or less

C Enter ‘1’ for your spouse. But, you may choose to enter -0- if you are married and have either a working spouse ormore than one job (this may help you avoid having too little tax withheld.) . . . . . . . . . . . . . . . . . . . C _________

D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . . D _________

E Enter ‘1’ if you file as head of household on your tax return (see conditions under Head of Household above) . . . . E _________

F Enter ‘1’ if you have at least$1,500 of child or dependent care expenses for which you plan to claim a credit . . . . . F _________

G Add lines A through F and enter total hereNote: This amount may be different from the number of exemptions you claim on your return. G _________

+ If you plan to itemize or claim adjustments to income and want to reduce your withholding , see the Deductionsand Adjustments Worksheet on page 2.

For accuracy,do all + If you are single and have more than one job, and your combined earning from all jobs exceed $30,000 OR ifworksheets you are married and have a working spouse or more than one job, and the combined earnings from all jobs exceedthat apply. $50,000, see the Two Earner/Two Job Worksheet on page 2 if you want to avoid having too little tax withheld.

+ If neither of the above situations applies, stop here and enter the number from line G on line 5 of Form W-4 below.

AAA4C103.1313.0906.DTA

+ If neither of the above situations applies, stop here and enter the number from line G on line 5 of Form W-4 below.

--------------------------------------Cut here and give the certificate to your employer. Keep the top portion for youe records.-----------------------------------------------

Form W-4 Employee’s Withholding Allowance Certificate OMB. No. 1515-0010

Department of the Treasury 20**Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see reverse.

1 Type or print your first name and middle initial Last Name 2 Your social security number

Home address (number and street or rural route)3 Single X Married Married, but withhold at higher Single rate

4-77 MECH INF Note:If married but legally separated or spouse is nonresident alien check Single Box.

City or town state, and ZIP code 4 If your last name differs from that on your social security card checkHINESVILLE, GA 31314 here and call 1-800-772-1213 for a new card . . . . . . .

5 Total number of allowances you are claiming(from line G above or from the worksheets on page 2 if they apply . . 5 3

6 Additional amount, if any you want withheld from each paycheck . . . . . . . . . . . . . 6 $ 0

7 I claim exemption from withholding for 1997 and I certify that I meet BOTH of the following conditions for exemption:

+ Last year I had a right to a refund of ALL Federal income tax withheld because I had NO tax liability; AND

+ This year I expect a refund of ALL Federal income tax withheld because I have NO tax liability.

If you meet both conditions, enter ‘EXEMPT’ here . . . . . . . . 7

Under penalties of perjury, I certify that I am entitled to the number of withholding allowances claimed on this certificate or entitled to claim exemptstatus.

Employee’s signature 8

Employer’s name and address (Employer: Complete 8 and 10 only if sending to the IRS) 9 Office code 10 Employer identificationnumber

(optional)

RILEY,JOHN

888 741245

Daniel Perron date 1 Sep 20**

13

STUDENT NOTE: I ONLY WANT TO CHANGE MY FEDERAL TAXES

34

The following soldier attended a weekend drill. Certificate of completion is attached.

Perron, Daniel 888-73-2366 01 **0910 thru **0916

Period attended: **0910 0700 AM to 14:30 PM**0915 0700 AM to 1000 AM**0916 0700 AM to 1000 AM

Joseph Winter

Joseph WinterCPT, INFCommanding

Drill Attendance Roster

AAA4C103.1313.0906.DTA

STUDENT NOTE:APC: 113588

35

DEPARTMENT OF THE ARMY55TH MECHANIZED INFANTRY DIVISION

CLAXTON, GEORGIA 30417

ORDER 043-022 10 APRIL 20**

BUNDELL, RONALD 888-74-0124 PFCHHC 2ND BDE GARDEN CITY, GEORGIA 31418

YOU ARE ORDER TO ACTIVE DUTY TRAINING [ADT] FOR THE PERIOD INDICATED.

PERIOD (TDY): 01 SEPTEMBER 20** TO 23 OCTOBER 20**REPORT TO: FINANCE SCHOOL, FORT JACKSON SCREPORTING TIME/DATE: NLT 1500HRS 01 SEPTEMBER 20**PURPOSE: DEPLOYMENT TO KS

ADDITIONAL INSTRUCTIONS:(A) DD FORM 1351-2 MUST BE SUBMITTED WITHIN 5 DAYS AFTER PERFORMANCE OF

DUTY.(B) YOU ARE RESPONSIBLE TO REPORT TO YOUR NEXT DUTY STATION IN

SATIFACTORY CONDITION AND BE ABLE TO PASS THE AFPT.

FOR ARMY USE:HOR: SAME AS SNLACCT CLASS: 21*2070 24-2356 P4F3111 S14040APC:E1E201PEBD: **0601

AAA4C103.1313.0906.DTA

DISTRIBUTION:3 - INDIVIDUAL6 - FINANCE UNIT ADMINISTRATOR1 - AC/S COMPTROLLER-BUDGET1 - IM, ASB

/S/FOR THE COMMANDERCHARLES J. DUETMAJ, AG, USAR

CHIEF, ADMIN SERVICES BRANCH

***********************************************FOR TRAINING PURPOSES ONLY***********************************************

36

DEPARTMENT OF THE ARMY55TH MECHANIZED INFANTRY DIVISION

CLAXTON, GEORGIA 30417

ORDER 043-018 21 AUGUST 20**

LEONARD, SAMUEL 888-74-0110HHC, 1ST BDE HINESVILLE, GEORGIA 31314

YOU ARE ORDER TO ACTIVE DUTY TRAINING [ADT] FOR THE PERIODINDICATED.

PERIOD (TDY): 01 SEPTEMBER 20** TO 18 SEPTEMBER 20**REPORT TO: AIR ASSAULT SCHOOL, FORT CAMPBELL KYREPORTING TIME/DATE: NLT 1500HRS 01 SEPTEMBER 20**PURPOSE: AIR ASSALT COURSE

ADDITIONAL INSTRUCTIONS:

(A) DD FORM 1351-2 MUST BE SUBMITTED WITHIN 5 DAYS AFTERPERFORMANCE OF DUTY.(B) YOU ARE RESPONSIBLE TO REPORT TO YOUR NEXT DUTY STATION INSATIFACTORY CONDITION AND BE ABLE TO PASS THE AFPT.

AAA4C103.1313.0906.DTA

FOR ARMY USE:HOR: SAME AS SNLACCT CLASS: 21*2070 24-2356 P4F3111 S14040APC:E1E201PEBD: **0601DISTRIBUTION:3 - INDIVIDUAL6 - FINANCE UNIT ADMINISTRATOR1 - AC/S COMPTROLLER-BUDGET1 - IM, ASB

/S/FOR THE COMMANDERCHARLES J. DUETMAJ, AG, USARCHIEF, ADMIN SERVICES BRANCH

37