Certification For Dla printable pdf download

Certification For Dla

CERTIFICATION FOR DLA

LIST THE MARINES’S OLD AND NEW PERMANENT ADDRESS BELOW.

COMPLETE THE STATEMENTS PROVIDED BELOW.

MEMBER DOES NOT RATE DLA OWN-RIGHT IF MEMBER RESIDED IN

BARRACKS AT OLD PERMANENT DUTY STATION.

“THIS IS MY ____ (NUMBER) CLAIM FOR DISLOCATION ALLOWANCE BASED ON A

PERMANENT CHANGE OF STATION DURING _

(FISCAL YEAR).

______________________

_____________________

PRINT NAME/RANK

SSN

______________________

__________________

PAYROLL SIGNATURE

DATE

A. OLD ADDRESS:

_______________________________________________________________________

________________________________________________________________________

B. NEW ADDRESS:

_____________________________________________________________________________________

______________________________________________________________________________________

COMPLETE THIS SECTION IF SPOUSE IS AN ARMED FORCES ACTIVE DUTY:

DID MEMBER OCCUPY SAME HOUSEHOLD AS SPOUSE BEFORE EXECUTING PCS?

___YES

___NO

DID MEMBER OCCUPY THE SAME HOUSEHOLD AS SPOUSE AFTER EXECUTING PCS?

___YES ___NO

IS MARINE’S SPOUSE CLAIMING DLA FOR MOVE INCIDENT TO A PCS?

___YES ___NO ___W/DEPN RATE ___W/O DEPN RATE

REMARKS:

______________________________________________________________________________________

___________________________________________________________________________________

REF: JFTR TABLE U5G-3

REF: MCO P4650.37 (MCTIM) PAR. 40323

Certification For Dla