RECEIPT FOR ACCOUNTABLE FORM - United States Army

1 ACCOUNTABLE form , IDENTIFIED BELOW, HAS BEEN ISSUED TO USING INDIVIDUAL DATE PREPARED form DESIGNATION, NUMBER, EDITION DATE AND TITLE PRINTER OR INSTALLATION MAKING SHIPMENT RECEIPT IS ACKNOWLEDGED OF form IDENTIFIED ABOVEDATE RECEIVED SEE INSTRUCTIONS ON PAGE 2. QUANTITY NAME OF INSTALLATION OR INDIVIDUAL SIGNATURE SERIALNUMBERS(Inclusive)INSTRUCTIONSDA form 410, MAR 2015 PAGE 1 OF 2 FROM (Including letter symbol)TO (Including letter symbol)CONSIGNEE - Upon RECEIPT of the shipment, return the signedcopy to the issuing AGENCY - Prepare this form in triplicate. Originaland one copy will be forwarded with the shipment to the con-signee and suspend the third copy until the signed copy isreturned by the approved by Comptroller General of , 10 Nov 48 PREVIOUS EDITIONS ARE NAME, GRADE OR TITLE OF ACCOUNTABLE OFFICERACCOUNTABLE 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 FOR ACCOUNTABLE form For use of this form , see DA PAM 25-40; the proponent agency is LC 2 OF 2 APD LC form 410, MAR 2015 ACCOUNTABLE form , IDENTIFIED BELOW, HAS BEEN ISSUED TO USING INDIVIDUAL DATE PREPARED form DESIGNATION, NUMBER, EDITION DATE AND TITLE PRINTER OR INSTALLATION MAKING SHIPMENT RECEIPT IS ACKNOWLEDGED OF form IDENTIFIED ABOVEDATE RECEIVED SEE INSTRUCTIONS ON PAGE 2.

2 QUANTITY NAME OF INSTALLATION OR INDIVIDUAL SIGNATURE SERIALNUMBERS(Inclusive)INSTRUCTIONSDA form 410, MAR 2015 PAGE 1 OF 2 FROM (Including letter symbol)TO (Including letter symbol)CONSIGNEE - Upon RECEIPT of the shipment, return the signedcopy to the issuing AGENCY - Prepare this form in triplicate. Originaland one copy will be forwarded with the shipment to the con-signee and suspend the third copy until the signed copy isreturned by the approved by Comptroller General of , 10 Nov 48 PREVIOUS EDITIONS ARE NAME, GRADE OR TITLE OF ACCOUNTABLE OFFICERACCOUNTABLE 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 FOR ACCOUNTABLE form For use of this form , see DA PAM 25-40; the proponent agency is LC 2 OF 2 APD LC form 410, MAR 2015 ACCOUNTABLE form , IDENTIFIED BELOW, HAS BEEN ISSUED TO USING INDIVIDUAL DATE PREPARED form DESIGNATION, NUMBER, EDITION DATE AND TITLE PRINTER OR INSTALLATION MAKING SHIPMENT RECEIPT IS ACKNOWLEDGED OF form IDENTIFIED ABOVEDATE RECEIVED SEE INSTRUCTIONS ON PAGE 2.

3 QUANTITY NAME OF INSTALLATION OR INDIVIDUAL SIGNATURE SERIALNUMBERS(Inclusive)INSTRUCTIONSDA form 410, MAR 2015 PAGE 1 OF 2 FROM (Including letter symbol)TO (Including letter symbol)CONSIGNEE - Upon RECEIPT of the shipment, return the signedcopy to the issuing AGENCY - Prepare this form in triplicate. Originaland one copy will be forwarded with the shipment to the con-signee and suspend the third copy until the signed copy isreturned by the approved by Comptroller General of , 10 Nov 48 PREVIOUS EDITIONS ARE NAME, GRADE OR TITLE OF ACCOUNTABLE OFFICERACCOUNTABLE 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 FOR ACCOUNTABLE form For use of this form , see DA PAM 25-40; the proponent agency is LC 2 OF 2 APD LC form 410, MAR 2015