Applicant'S Monthly Financial Statement - Da Form 3072-2

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DATE
APPLICANT'S MONTHLY FINANCIAL STATEMENT
For use of this form, see AR 601-210; the proponent agency is ODCSPER
1.
LAST NAME, FIRST NAME, MIDDLE INITIAL
2.
RESIDENCE OF DEPENDENTS WHILE SEPARATED FROM APPLICANT
3.
CURRENT INCOME
$
Salary
1
2
$
Other income (current)
source
3
Other income (if enlisted)
$
source
4a.
Liabilities to apply against above income
4b.
Liabilities to apply against military income
$
$
Rent
Rent or house notes
Utilities
Utilities
Food
Food
Medical
Clothing
Clothing
Insurance (Life)
Insurance (Life)
Insurance (Auto)
Insurance (Auto)
Car operating expenses
Car operating expense
Car notes
Car notes
Payment on other debts
4
Payment on other debts
4
Other indebtedness or financial obligations
Other indebtedness or financial obligations
TOTAL
$
TOTAL
$
5.
Assets
$
Savings
Rooms of furniture owned
Bonds, stocks, etc.
Number of vehicles
Furniture
Motor vehicles
Other assets
$
TOTAL
6.
ADDITIONAL INFORMATION OR REMARKS
(In the event a move of dependents is indicated, include information as to disposition of furniture, if applicable, any other information you
feel is pertinent to your current and future financial stability.)
The above is true to the best of my knowledge, and includes all current and known future obligations and/or demands against my income.
WITNESSED
SIGNATURE OF APPLICANT
1
If applicant is currently unemployed, indicate salary for last employment and employment termination date.
2
Indicate additional current monthly income including spouse's salary, if employed. If income is from more than one source, indicate each
source and amount of that source.
3
Indicate anticipated income other than military salary if enlistment is approved.
4
See item 23, DA Form 3072-1.
DA FORM 3072-2, JUL 1975
APD LC v2.00ES
PREVIOUS EDITION IS OBSOLETE

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