Transcription of SWORN STATEMENT For use of this form, see AR …
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SWORN STATEMENT For use of this form, see AR …
THE BOTTOM OF EACH ADDITIONAL PAGE MUST BEAR THE INITIALS OF THE PERSON MAKING THE STATEMENT , AND PAGE NUMBERMUST BE INDICATED. ADDITIONAL PAGES MUST CONTAIN THE HEADING " STATEMENT OFSWORN STATEMENT For use of this form, see AR 190-45; the proponent agency is PMG. PAGE 1 OF3. TIME6. SSN2. DATE (YYYYMMDD)I,DA FORM 2823, DEC 1998, IS OBSOLETE8. ORGANIZATION OR ADDRESS10. EXHIBIT11. INITIALS OF PERSON MAKING STATEMENTDA FORM 2823, NOV 20061. LOCATION5. LAST NAME, FIRST NAME, MIDDLE NAME4. FILE NUMBER7. GRADE/STATUS, WANT TO MAKE THE FOLLOWING STATEMENT UNDER OATH:PAGESDATEDTAKEN ACT STATEMENTAUTHORITY: PRINCIPAL PURPOSE: ROUTINE USES: DISCLOSURE: Title 10, USC Section 301; Title 5, USC Section 2951; 9397 Social Security Number (SSN).
the bottom of each additional page must bear the initials of the person making the statement, and page number must be indicated. additional pages must contain the heading "statement of
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