Da Form 4137 PDF Details

A Da Form 4137 is a Department of Defense form that is used to request reimbursement for personal property damage. This form must be completed and submitted to the military organization responsible for the damage. The reimbursement amount will be based on the actual cost of repairs or replacement, minus any applicable insurance payments. Reimbursement may also be available for associated costs such as transportation and storage. For more information on how to complete and submit a Da Form 4137, contact the appropriate military organization.

QuestionAnswer
Form NameDa Form 4137
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesfillable form 4137, custody da chain form, evidence form, custody da chain

Form Preview Example

EVIDENCE/PROPERTY CUSTODY DOCUMENT

For use of this form see AR 190-45 and AR 195-5; the proponent agency is US Army Criminal Investigation Command

MPR/CID SEQUENCE NUMBER

CRD REPORT/CID ROI NUMBER

RECEIVING ACTIVITY

LOCATION

NAME, GRADE AND TITLE OF PERSON FROM WHOM RECEIVED

ADDRESS (Include Zip Code)

OWNER

OTHER

LOCATION FROM WHERE OBTAINED

REASON OBTAINED

TIME/DATE OBTAINED

ITEM

DESCRIPTION OF ARTICLES

 

QUANTITY

NO.

(Include model, serial number, condition and unusual marks or scratches)

 

 

 

CHAIN OF CUSTODY

 

 

 

 

 

 

ITEM

DATE

RELEASED BY

RECEIVED BY

PURPOSE OF CHANGE

NO.

OF CUSTODY

 

 

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

DA FORM 4137, 1 JUL 76

Replaces DA FORM 4137, 1 Aug 74 and

 

 

 

USAPPC V1.00

 

DA FORM 4137-R Privacy Act Statement

 

 

DOCUMENT

 

26 Sep 75 Which are Obsolete

LOCATION

 

NUMBER

 

 

 

 

CHAIN OF CUSTODY (Continued)

 

 

 

 

 

 

ITEM

DATE

RELEASED BY

RECEIVED BY

PURPOSE OF CHANGE

NO.

 

 

 

OF CUSTODY

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

SIGNATURE

SIGNATURE

 

 

 

 

 

 

 

 

NAME, GRADE OR TITLE

NAME, GRADE OR TITLE

 

 

 

 

 

 

 

 

 

 

 

 

FINAL DISPOSAL ACTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RELEASE TO OWNER OR OTHER (Name/Unit)

 

 

 

 

 

 

 

DESTROY

 

 

 

 

 

 

 

 

 

 

OTHER (Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FINAL DISPOSAL AUTHORITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM(S)

 

 

 

ON THIS DOCUMENT, PERTAINING TO THE INVESTIGATION INVOLVING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Grade)

 

 

 

 

 

 

 

 

 

(IS) (ARE) NO LONGER

 

 

 

(Name)

(Organization)

 

 

REQUIRED AS EVIDENCE AND MAY BE DISPOSED OF AS INDICATED ABOVE.

(If article(s) must be retained, do not sign, but explain in separate

 

 

 

 

 

 

correspondence.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Typed/Printed Name, Grade, Title)

 

 

(Signature)

(Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WITNESS TO DESTRUCTION OF EVIDENCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THE ARTICLE(S) LISTED AT ITEM NUMBER(S)

 

 

 

(WAS) (WERE) DESTROYED BY THE EVIDENCE

 

 

CUSTODIAN, IN MY PRESENCE, ON THE DATE INDICATED ABOVE.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Typed/Printed Name, Organization)

 

 

 

 

(Signature)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

USAPPC V1.00

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