Summarized Record Of Proceedings Under Article 15 printable pdf download

SUMMARIZED RECORD OF PROCEEDINGS UNDER ARTICLE 15, UCMJ

For use of this form, see AR 27-10; the proponent agency is TJAG.

See Notes on Reverse Before Completing Form

This form will be used only in cases involving enlisted personnel and then ONLY when no punishment OTHER THAN oral admonition

or reprimand, restriction for 14 days or less, extra duties for 14 days or less, or a combination thereof has been imposed.

NAME

GRADE

SSN

UNIT

1. On ____________________________________, the above service member was advised that I was considering imposition of nonjudicial

punishment under the provisions of Article 15, UCMJ, Summarized Proceedings, for the following misconduct:

2. The member was advised that no statement was required, but that any statement made could be used against him or her in the

proceeding or in a court-martial. The member was also informed of the right to demand trial by court-martial

, the right to present

matters in defense, extenuation and/or mitigation, that any matters presented would be considered by me before deciding whether to

impose punishment, the type or amount of punishment, if imposed, and that no punishment would be imposed unless I was convinced

beyond a reasonable doubt that the service member committed the misconduct. The service member was afforded the opportunity to

take 24 hours to make a decision regarding these rights. No demand for trial by court-martial was made. After considering all matters

presented, the following punishment was imposed:

3. The member was advised of the right to appeal to the ___________________________________ within 5 calendar days, that an appeal made

after that time could be rejected as untimely, and that the punishment was effective immediately unless otherwise stated above. The

member:

Elected immediately not to appeal

Requested time to decide whether to appeal and the decision is indicated in item

4, below.

DATE

NAME, GRADE, AND ORGANIZATION OF IMPOSING

SIGNATURE

COMMANDER

4. (Initial appropriate block, date, and sign)

I do not appeal b.

I appeal and do not submit matters for consideration

I appeal and submit additional

matters

DATE

NAME AND GRADE OF SERVICE MEMBER

SIGNATURE

5. After consideration of all matters presented in appeal, the appeal is:

Denied

Granted as follows:

DATE

NAME, GRADE, AND ORGANIZATION OF COMMANDER

SIGNATURE

DATE

SIGNATURE OF SERVICE MEMBER

6. I have seen the action taken on my appeal.

9 10 11

ALLIED DOCUMENTS AND/OR COMMENTS

DA FORM 2627-1, AUG 84

EDITION OF NOV 82 IS OBSOLETE

USAPPC V1.00

Summarized Record Of Proceedings Under Article 15

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