Da Form 410 - Receipt Of Accountable Form Page 2

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RECEIPT FOR ACCOUNTABLE FORM
For use of this form, see DA PAM 25-40; the proponent agency is OAASA.
SERIAL
NUMBERS
(Inclusive)
FROM (Including letter symbol)
TO (Including letter symbol)
DATE PREPARED
ACCOUNTABLE FORM IDENTIFIED BELOW IS BEING FORWARDED TO YOUR STATION TODAY.
UPON ARRIVAL ACCOUNTABLE OFFICER IS REQUESTED TO COMPLETE AND RETURN THIS
RECEIPT TO THE INSTALLATION OR ORGANIZATION NAMED BELOW.
ACCOUNTABLE FORM, IDENTIFIED BELOW, HAS BEEN ISSUED TO USING INDIVIDUAL
QUANTITY
FORM DESIGNATION, NUMBER, EDITION DATE AND TITLE
PRINTER OR INSTALLATION MAKING SHIPMENT
RECEIPT IS ACKNOWLEDGED OF FORM IDENTIFIED ABOVE
DATE RECEIVED
NAME OF INSTALLATION OR INDIVIDUAL
TYPED NAME, GRADE OR TITLE OF ACCOUNTABLE
SIGNATURE
OFFICER
Form approved by Comptroller General of U.S., 10 Nov 48
SEE INSTRUCTIONS ON PAGE 2.
DA FORM 410, MAR 2015
PAGE 1 OF 2
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.00ES
INSTRUCTIONS
ISSUING AGENCY - Prepare this form in triplicate. Original
and one copy will be forwarded with the shipment to the con-
signee and suspend the third copy until the signed copy is
returned by the consignee.
CONSIGNEE - Upon receipt of the shipment, return the signed
copy to the issuing agency.
DA FORM 410, MAR 2015
PAGE 2 OF 2
APD LC v1.00ES

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