The DA 2823 form is a sworn statement used by the U.S. Army to document potential criminal activity and maintain order within its ranks. This form allows individuals to provide detailed accounts of incidents under oath, ensuring that the information can be used for investigations and disciplinary actions. By completing this form, service members contribute to the Army's commitment to discipline and accountability.
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SWORN STATEMENT
For use of this form, see AR 190-45; the proponent agency is PMG.
PRIVACY ACT STATEMENT
AUTHORITY:
Title 10, USC Section 301; Title 5, USC Section 2951; E.O. 9397 Social Security Number (SSN).
PRINCIPAL PURPOSE:
To document potential criminal activity involving the U.S. Army, and to allow Army officials to maintain discipline,
law and order through investigation of complaints and incidents.
ROUTINE USES:
Information provided may be further disclosed to federal, state, local, and foreign government law enforcement
agencies, prosecutors, courts, child protective services, victims, witnesses, the Department of Veterans Affairs, and
the Office of Personnel Management. Information provided may be used for determinations regarding judicial or
non-judicial punishment, other administrative disciplinary actions, security clearances, recruitment, retention,
placement, and other personnel actions.
DISCLOSURE:
Disclosure of your SSN and other information is voluntary.
1.
LOCATION
2. DATE (YYYYMMDD)
3. TIME
4. FILE NUMBER
5.
LAST NAME, FIRST NAME, MIDDLE NAME
6. SSN
7. GRADE/STATUS
8.
ORGANIZATION OR ADDRESS
9.
I,
, WANT TO MAKE THE FOLLOWING STATEMENT UNDER OATH:
10. EXHIBIT
11. INITIALS OF PERSON MAKING STATEMENT
Page 1 of 3
ADDITIONAL PAGES MUST CONTAIN THE HEADING "STATEMENT OF TAKEN AT DATED
THE BOTTOM OF EACH ADDITIONAL PAGE MUST BEAR THE INITIALS OF THE PERSON MAKING THE STATEMENT, AND PAGE NUMBER MUST BE INDICATED.
DA FORM 2823, NOV 2006
PREVIOUS EDITIONS ARE OBSOLETE.
APD AEM v1.04ES
USE THIS PAGE IF NEEDED. IF THIS PAGE IS NOT NEEDED, PLEASE PROCEED TO FINAL PAGE OF THIS FORM.
STATEMENT OF
TAKEN AT
DATED
9.STATEMENT (Continued)
INITIALS OF PERSON MAKING STATEMENT
Page 2 of 3
AFFIDAVIT
, HAVE READ OR HAVE HAD READ TO ME THIS STATEMENT WHICH BEGINS ON
PAGE 1, AND ENDS ON PAGE
3 . I FULLY UNDERSTAND THE CONTENTS OF THE ENTIRE STATEMENT MADE BY ME. THE
STATEMENT IS TRUE. I HAVE INITIALED ALL CORRECTIONS AND HAVE INITIALED THE BOTTOM OF EACH PAGE CONTAINING THE STATEMENT. I HAVE MADE THIS STATEMENT FREELY WITHOUT HOPE OF BENEFIT OR REWARD, WITHOUT THREAT OF PUNISHMENT, AND WITHOUT COERCION, UNLAWFUL INFLUENCE, OR UNLAWFUL INDUCEMENT.
(Signature of Person Making Statement)
WITNESSES:
Subscribed and sworn to before me, a person authorized by law to
administer oaths, this
day of
,
at
.
(Signature of Person Administering Oath)
(Typed Name of Person Administering Oath)
(Authority To Administer Oaths)
Page 3 of 3
The DA 2823 form, known as the Sworn Statement, is often accompanied by other important documents that facilitate investigations and ensure proper documentation. Below are four commonly used forms that may accompany the DA 2823.
These forms and documents work together with the DA 2823 to create a comprehensive record that supports the investigation process. Proper documentation is vital for upholding accountability and ensuring justice within the military framework.