Record Of Supplementary Action Under Article 15, Ucmj
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1RECORD OF SUPPLEMENTARY ACTION UNDER ARTICLE 15, UCMJ
For use of this form, see AR 27-10, Chapter 3; the proponent agency is OTJAG-CL.
NAME
GRADE
SSN
UNIT & LOCATION
TYPE OF SUPPLEMENTAL ACTION
(OTHER THAN SUPERIOR AUTHORITY ACTING ON APPEAL) (CHECK APPROPRIATE BOX)
SUSPENSION
(Complete Item 1 below)
REMISSION
(Complete Item 3 below)
MITIGATION
(Complete Item 2 below)
SETTING ASIDE (Complete Item 4 below)
VACATION OF SUSPENSION
(Complete Item 5 below)
1. SUSPENSION
The punishment(s) of:
imposed on the above service member on
(date of punishment)
suspended and will automatically be remitted if not vacated before
.
(date)
2. MITIGATION
The punishment(s) of:
imposed on the above service member on
mitigated to
(date of punishment)
3. REMISSION
The punishment(s) of:
imposed on the above service member on
remitted.
(date of punishment)
4. SETTING ASIDE
The punishment(s) of:
imposed on the above service member on
set aside on the basis of
(date of punishment)
All rights, privileges, and property affected are hereby restored.
5. VACATION OF SUSPENSION
a. The suspension of the punishment(s) of:
imposed on the above service member on
hereby vacated. The unexecuted portion(s) of the punishment(s) will be
(date of punishment)
duly executed (date of punishment).
b. Vacation is based on the following offense(s):
c. The service member
given an opportunity to rebut (see para. 3-25, AR 27-10).
(was / was not)
d. The service member
present at the vacation proceeding (see para. 3-25, AR 27-10).
(was / was not)
6. THE ORIGINAL DA FORM 2627 WAS FILED AS FOLLOWS:
Performance section of the OMPF
Restricted section of the OMPF.
NA as soldier was an E-4 or below at start of proceedings
7. BY MY ORDER:
AS THE OFFICER WHO IMPOSED
AS THE SUCCESSOR IN COMMAND TO THE
AS THE SUPERIOR AUTHORITY
THE PUNISHMENT
IMPOSING OFFICER
NAME, RANK, AND ORGANIZATION OF COMMANDER
SIGNATURE
DATE
DA FORM 2627-2, OCT 2011
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.01
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