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Section 1, Place an "X" in which action you will be performing

Section 2. Your Company Name & Address ALONG WITH your Account Number in the

top right hand corner of the block.

Section 3. Date you are filling the form out

Section 4. Your internal "outgoing" tracking number

Section 5. Actual transaction date for destruction or inventory

Section 6. Your internal "incoming" tracking number

Section 7. The Dept. of Defense or Company Name & Address ALONG WITH their

Account Number in the top right hand corner of the block.

Section 8. Accounting code listing

Section 9. List material type; example: "KSV-21", "KOV-14" etc...

Section 10. How many of the same type of material; example: "1", "2"

Section 11. (Beginning) If a sequential amount, list the first number; example: "001"

Section 11. (Ending) If a sequential amount in "Beginning" list last number; example

"004", Note: Section 10 line 1 (quantity) should be "4" for the total

sequential quantity.

Section 12. ALC

Section 13. List any remarks; example: "Accounted for", "Destroyed"

Section 14. Place an "X" in action performed

Section 15a/c. Normally the primary custodian or recipient printed name & signature

Section 15b. The grade of the person signing in section 15a. example: "CTR", "SSgt"

Section 15d. Service. example: "CIV", "USAF"

Section 16. Place an "X" in the block for the second signatory in 16a.

Section 16a/c. Normally the witness printed name & signature

Section 16d. Service. example: "CIV", "USAF"

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