Da Form 3499 PDF Details

Military members complete a variety of forms while serving in the military. One important form is the Da Form 3499. This form is used to report information about an individual's military service. The form must be completed accurately and honestly in order to ensure proper benefits are received by the service member. There are specific instructions for completing the form, and it is important to understand these instructions in order to complete the form correctly. The following information will provide an overview of how to complete the Da Form 3499.

QuestionAnswer
Form NameDa Form 3499
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names2011, APD, 3499, contentions

Form Preview Example

APPLICATION FOR RELIEF FROM COURT-MARTIAL FINDINGS AND/OR SENTENCE

DOCKET NUMBER

UNDER THE PROVISIONS OF TITLE 10, UNITED STATES CODE, SECTION 869

 

 

For use of this form, see AR 27-10; the proponent agency is TJAG.

(For TJAG Use)

 

 

 

 

 

 

 

(Read Instructions on Reverse BEFORE Completing Application)

 

 

 

 

 

 

 

DATA REQUIRED BY THE PRIVACY ACT OF 1974

 

AUTHORITY:

10 USC 869 AND 3037.

 

 

 

PRINCIPAL PURPOSES:

To appeal your court-martial findings and/or sentence to The Judge Advocate General under the provisions of Article 69(b), UCMJ.

ROUTINE USES:

To evaluate your appeal and aid in determining whether the relief sought is appropriate.

 

DISCLOSURE:

Disclosure of the requested information is voluntary. Failure to provide complete information may delay evaluation of your appeal

 

and may result in incomplete evaluation of your appeal.

 

 

 

 

 

 

1. NAME OF CONVICTED PERSON (Last, First, MI)

 

 

 

 

 

 

 

 

2. PRESENT GRADE OR STATUS

3. DATE OF TRIAL

 

4. PLACE OF TRIAL

 

 

 

 

 

 

5. COMMAND CONVENING COURT-MARTIAL

 

6. TYPE OF COURT-MARTIAL

 

 

 

 

 

SUMMARY

SPECIAL

 

 

 

7. OFFENSE(S) CHARGED (Article(s) and brief description of offense(s))

8. PLEA(S)

 

 

9. FINDINGS OF THE COURT-MARTIAL, SENTENCE ADJUDGED, AND LATER MODIFICATIONS, IF ANY:

 

 

10. I BELIEVE RELIEF IN THE ABOVE NAMED COURT-MARTIAL IS JUSTIFIED BECAUSE: (State fully the reasons you believe relief should be granted.

The reasons must relate to at least one of the five grounds set forth in Article 69(b), UCMJ.)

 

 

 

 

 

 

 

11. RELIEF REQUESTED

 

 

 

 

 

 

 

12. NAME AND ADDRESS OF COUNSEL ASSISTING WITH APPLICATION, IF ANY: (Include ZIP Code)

 

 

 

 

 

 

DA FORM 3499, JUL 2014

 

PREVIOUS EDITION IS OBSOLETE.

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13. ENCLOSED ARE:

 

14. PRESENT ADDRESS OF APPLICANT (Include ZIP Code) (Forward

 

 

A COPY OF COURT-MARTIAL

SWORN AFFIDAVITS,

notification of any change)

 

 

 

 

 

 

 

ORDER(S) PROMULGATING

DOCUMENTS, OR OTHER

 

 

 

RESULT OF TRIAL, AND

MATTERS IN SUPPORT

 

 

 

LATER MODIFICATION(S), IF

OF APPLICATION

 

 

 

ANY

 

 

 

 

 

 

 

15. OATH OR AFFIRMATION: (See instruction 5)

I DO SOLEMNLY [SWEAR] [AFFIRM AND DECLARE] THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE STATEMENTS CONTAINED IN THIS APPLICATION

(including accompanying matters submitted) ARE TRUE [SO HELP ME GOD]. I MAKE THIS ASSERTION UNDER THE PAINS AND PENALTIES OF FALSE SWEARING.

(Title 18 U.S. Code, Section 1001 provides a penalty of not more than $10,000 fine, five years imprisonment, or both, for knowingly making false statements in connection with this application.)

SIGNATURE OF APPLICANT

NAME OF APPLICANT

SWORN TO BEFORE ME AND SUBSCRIBED IN MY PRESENCE THIS

 

DAY OF

 

20

(Seal)

INSTRUCTIONS

(Read ALL Instructions Before Completing Form)

1.Application for relief from the findings or sentence, or both, of a court-martial case which has been finally reviewed, but has not been reviewed by the United States Army Court of Criminal Appeals. Army Regulation 27-10, which is summarized in these instructions.

2. Article 69(b) of the Uniform Code of Military Justice (Title

10, US Code, Section 869(b)) provides that: "The findings or sentence, or both, in a court-martial case not reviewed under subsection (a) or under section 866 of this title (Article 66)

may be modified or set aside, in whole or in part, by the Judge Advocate General on the ground of newly discovered evidence, fraud on the court, lack of jurisdiction over the accused or the offense, error prejudicial to the substantial rights of the accused, or the appropriateness of the sentence."

3.Relief is authorized only when (1) the post-trial process of legal review of the case has been completed, and (2) at least one of the five grounds set forth in paragraph 2 above has been established to the satisfaction of The Judge Advocate General. Application for relief on the ground of sentence appropriateness normally will not be considered if the application is based solely on the quality of the behavior or duty performance of the convicted person after trial, or on any evidence of personal hardship not admitted at trial. For other avenues of relief, see Title 10, U.S. Code, Section 874 (Article 74, UCMJ) or 32 CFR 581.3 (Army Board for the Correction of Military Records).

4.Except as provided in this paragraph, the application must be signed by the individual convicted by court-martial. In those cases where the individual is deceased, incapable of making ap- plication, or whose whereabouts are unknown, The Judge Advocate General may permit application to be made by such person as he/she determines to be competent and suitable, and to have a proper interest therein, including, but not limited to, a spouse, parent, or relative of the person convicted by court- martial substantially affected as a result of the findings or sentence, or both, which the applicant maintains should be vacated or modified. If application is not signed by the indi- vidual convicted, full explanation should be made and attached.

5.The application must be submitted under oath or affirmation executed before an official authorized to administer oaths. A notary public is usually authorized to perform this function. Military personnel on active duty may execute the application before a judge advocate or other officer authorized by Article 136(a) of the Uniform Code of Military Justice to administer oaths. Knowingly making a false statement in connection with an application for relief can be punished by a $10,000 fine, five years imprisonment, or both.

6.Applicant's entry in Item 11 should describe the reasons for the request for relief. Relevant facts which support the applicant's contentions should be included. Legal authorities may be presented in this section, or may be attached in the form of a legal brief, if applicant desires. Other matters tending to support applicant's allegations of error or impropriety, including but not limited to, sworn affidavits, official records, and other documents, may be attached. The applicant bears the burden of establishing an alleged impropriety. Unsupported allegations of matters outside the record of trial will seldom be sufficient to warrant relief.

7.A copy of the court-martial order (or the record of trial in the case of

a summary court-martial) promulgating the findings, sentence, and action of the convening authority in the case, and a copy of any later modifying order(s), if available to the applicant, should be submitted with the application.

8.A copy of the record of trial in cases other than summary courts-martial should not be submitted.

9.If the applicant is a member of the command which convened the court -martial, or of a unit within the same general court-martial jurisdiction, the application should be submitted through the Office of the Staff Judge Advocate of that general court-martial jurisdiction. In all other cases, applications will be submitted directly to Office of The Judge Advocate General, ATTN: Criminal Law Division, 2200 Army Pentagon, Washington D.C. 20310-2200 and must be received on or before the last day of the 2-year period beginning on the date the sentence was approved by the convening authority. Failure to file within the prescribed time may be excused by The Judge Advocate General of good cause established by the applicant.

10.Submit only the original of this form.

11.Type, or print all entries in ink.

12.If space allotted is insufficient, attach additional sheet(s), indicating item number continued thereon.

13.Complete all items; if inapplicable, enter "None".

14.Applicant should send notice of change in address while application is pending to The Judge Advocate General at the address shown in instruction 9 above.

15.Applicant will be notified of receipt of application by The Judge Advocate General, and the result of review, when completed.

DA FORM 3499, JUL 2014

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How to Edit Da Form 3499 Online for Free

UCMJ can be filled out very easily. Simply try FormsPal PDF editor to complete the task promptly. To make our editor better and simpler to utilize, we consistently implement new features, with our users' suggestions in mind. With a few easy steps, you'll be able to begin your PDF editing:

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This form will need specific information to be typed in, thus you need to take your time to type in what is required:

1. Complete your UCMJ with a number of necessary blanks. Note all the necessary information and be sure nothing is omitted!

Completing section 1 of USC

2. Once the last section is complete, it is time to include the required particulars in FINDINGS OF THE COURTMARTIAL, I BELIEVE RELIEF IN THE ABOVE, and RELIEF REQUESTED so you can proceed further.

The way to fill out USC part 2

3. The following part is focused on RELIEF REQUESTED, NAME AND ADDRESS OF COUNSEL, DA FORM JUL, PREVIOUS EDITION IS OBSOLETE, and Page of APD LC v - complete all these empty form fields.

Step number 3 of submitting USC

4. This section comes with all of the following empty form fields to consider: ENCLOSED ARE, A COPY OF COURTMARTIAL ORDERS, OATH OR AFFIRMATION See, SWORN AFFIDAVITS DOCUMENTS OR, PRESENT ADDRESS OF APPLICANT, I DO SOLEMNLY SWEAR AFFIRM AND, including accompanying matters, Title US Code Section provides a, SWORN TO BEFORE ME AND SUBSCRIBED, DAY OF, Seal, SIGNATURE OF APPLICANT, and NAME OF APPLICANT.

USC completion process shown (part 4)

Be really careful while filling in A COPY OF COURTMARTIAL ORDERS and DAY OF, since this is where many people make errors.

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