Da Form 410 - Receipt For Accountable Form (Ar 25-30) Page 2

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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
SEE INSTRUCTIONS ON REVERSE.
RECEIPT FOR ACCOUNTABLE FORM (AR 25-30)
DA FORM 410, JUN 1955
Form approved by Comptroller
REPLACES EDITION OF 1 JAN 53, AND
DA FORM 410-1, 1 JAN 53, WHICH ARE
General of U.S., 10 Nov 48
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.

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