Da Form 4697 - Department Of The Army Report Of Survey Page 2
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221. APPOINTING AUTHORITY
22. STATION
23. DATE
24. NAME, GRADE OF SURVEYING OFFICER
25.
YOU ARE APPOINTED SURVEYING OFFICER BY ORDER OF:
(Typed name, grade of Appointing Authority)
26. FINDINGS AND RECOMMENDATION
I have examined all available evidence as shown in exhibits
to
and as indicated below have personally investigated the
same and it is my belief that the article(s) listed hereon and/or attached to sheets, total cost $
27.
a. ACTUAL LOSS
b. AMOUNT CHARGED
c. LOSS TO GOVERNMENT
RECOMMEND PECUNIARY CHARGE
28. DATE
29a. TYPED NAME, GRADE OF SURVEYING OFFICER
b. SIGNATURE
30.
I have examined the findings and recommendations of the Surveying Officer on this report of survey and the exhibits
to
and
desire to make a statement which is attached hereto;
do not desire to make a statement. I am aware
of my right to legal advice in preparing the statement and, if a pecuniary charge is finally approved, to make appeal and (If an en-
listed man) my right to request remission of indebtedness. I am/am not the accountable officer for the lost or damaged property.
The property was/was not my personal arms or equipment.
31. DATE
32a. TYPED NAME, GRADE OF INDIVIDUAL BEING CHARGED
b. SIGNATURE
34. COMMENTS
33. RECOMMENDATION BY
THE APPOINTING
AUTHORITY
CONCUR
NONCONCUR
35. DATE
36a. TYPED NAME, GRADE & TITLE OF APPOINTING AUTH
b. SIGNATURE
37. APPROVING AUTHORITY
38. PECUNIARY CHARGE
a.
REJECTED. Investigation is required. Appoint a survey officer. Date
Initials
b.
REJECTED. Investigation incomplete. Additional information required. Date
Initials
a. ACTUAL LOSS
c.
APPROVED BY AUTHORITY OF THE SECRETARY OF THE ARMY.
b. AMOUNT CHARGED
c. LOSS TO GOVERNMENT
39. DATE
40a. TYPED NAME, GRADE & TITLE OF APPROVING AUTH
b. SIGNATURE
REVERSE, DA FORM 4697, SEP 81
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