Da Form 3955 - Change Of Address And Directory Card

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CLICK TO RETURN TO COVER PAGE
PRINT NAME
(Last, First, MI)
GRADE
SSN
PURGE DATA
NEW ORGANIZATION (Complete Designation)
BOX NUMBER
DATA REQUIRED BY THE PRIVACY ACT OF 1974. AUTHORITY: Title 39 USC and DOD/Postal Service Aggreement, 2
Feb. 59. PRINCIPLE PURPOSE: To route and forward (Directory) mail. ROUTINE USES: Used by Army military and civilian
personnel in mail functions and address inquires. Data are inspected bt commanders, postal officers, and military and
civilian inspectors. DISCLOSURE: Voluntary. However, failure to provide the requested information could result in delay/in-
ability to forward mail.
OLD MAILING ADDRESS (Include BOX No., if any, and
NEW MAILING ADDRESS (Include ZIP Code)
ZIP Code)
Address - Line 1 (ex. USAG-J Unit 45013)
Address - Line 2 (ex. Box 1234)
Address - Line 3 (ex. APO, AP 96338)
DATE DEPARTED OLD ORG:
DATE DUE NEW ORG:
QUARTERS/OFF POST ADDRESS
REMARKS
(IF DEPARTING, COMPLETE BELOW ITEMS)
I DO
CONSENT:
I DO NOT CONSENT TO
RELEASE THE ABOVE HOME ADDRESS
HEADQUARTERS ISSUING ORDERS
OR SSN TO THIRD PARTIES.
SIGNATURE
DATE
ORDER NUMBER
ORDER DATE
DA
3955
FORM
EDITION OF 1 AUG 78 MAY BE USED.
1 FEB 79
CHANGE OF ADDRESS AND DIRECTORY CARD
For use of this form, see AR 600-8-3, the proponent agency is ODCSPER
RESET ALL
NEO DigiPacket - US Army Japan - Version 1

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