Commander's Report re: Article 15 Findings (0058-04-C1D939-82650)

•_. SUSPENSE DATE (YYYYMMDD)
COMMANDER'S REPORT OF DISCIPLINARY OR ADMINISTRATIVE ACTION
For use of this form, see AR 190-45; the proponent agency is Office of the Provost Marshal General
•. PRIVACY ACT STATEMENT AUTHORITY:_Tree 10 USC Section 301; Title 5 USC Section 2951: 6.0. 9397 dated November 22, 1943 (SSN). PRINCIPAL3To provide commanders and taw enforcement officiate with means by which infomiation may be accurately identified. ROUTINE USES:_Your social security number is used as an additIonal/asernate means of identification to facilitate filing and retrieval.
DISCLOSURE:_Disclosure of your social Security number is voluntary,
1. THRU 2. TO 3. FROM Commander Commander Commander
1/185th Armor BN C CO. 1/185th Armor BN 78th MP Det CID (-)Camp Scania, APO AE 09331 Camp Cedar II, APO AE 09331 APO AE 09331
4. USACRC CONTROL NUM8ER 5. MP REPORT NUMBER_' 6. SUB•1NSTALIATION IDENTIFIER
0058-04-CID939.82650
The first Lieutenant Colonel in the chain ol command is responsible and accounted@ tor completing DA Forman,' with Support documentation (copee of Article 15s.
court-martial orders, reprimands, etc) (or CO VSACIDC Investigations. The unit and brigade commander or their equivalent will also receive a copy of the DA Fenn 1833

Ur all USACICIC loom:Nations_
COMPady troop, and battery level commanders are responseole and accountable for completing OA Form 433 with supporting documentation In an casers.investigated byMPI, civ48an detecduea employed by the Department arm Army, and eta PHO. Accurate and complete OA 4633 tirspoedon reports are required to meet In deriabon,command, SIODA, 000, and Momal statutory reporting requirements. The data Is used to Identify crime bonds, establish commend programs In raw enforcement and
other emiutass, and to ensure Oral resources are made *veletas to swoon coin...enders who must address Issues of earlier end limey member incescaene.
inco,,,i.evreakmas, a construe of as offense at =limonite may se tor a dittenint, or IOW Intdoded Offense. List Me offense lot "diet the indbrisual was convicted
al coud4re Mal in the remarks tethal.
Block S. Provost Marshes must enter she Winery Police Report number for all calm referred to conanonclare.
Block B. This block is seed tO enter report number from a civilian law enaorcement agency poke report Other Information on the careen low enforcement agency

(e.g. civilian law entomement agency address) may be entered In the remarks oaction.
7. NAME OF SUBJECT_, A40 8. GRADE 9. SSN 10. DATE OF BIRTH
YYYYMMDD)
(-------.......S5

NE= 11 b. DATE OF _
lie. OFFENSE(s) Ito AC110N T 110. IF N_ACTION TAKEN. EXPLAIN;
OFFENSE(s)(YWYMMDD)
Obstruction of Justice 20040701 YES, _ NO •

YES •3NO 0
(-) (-7.) (.0 -r
¦3
YE No il
... taW3k-2)
12. ACTION TAKEN (cheek all that aochl
• Sub)ect was advised that although no action was taken, the report would be retained In Army records and that requests for amendment,correction, or expunger ent may be submitted IAW AR 190-45 (MP Reports) or AR 195-2 (CID Reports).
• a NON-ADVERSE PERSONNEL ACTION REFERRAL: REFERRED TO (Check appropriate blocks);DATE REFERRED (YYYYMMDD) _(YYYYMMOD)
DATE RESPONDED F a FAMILY ADVOCACY
D = DRUG/ALCOHOL ABUSE
S a SPECIAL REFERRAL
E = EQUAL OPPORTUNITY
L a LEGAL OFFICE
M = MENTAL HEALTH
R = RELIEF AGENCY

MI, b. ADVERSE PERSONNEL ACTION:
REPRIMAND_ORAL_r4 WRITTEN
FILED:_rilLocALLY •OMPF
_ LETTER OF CONCERN/COUNSELING

_
ADVERSE OER/NCOER COMMENT
_
RELIEF FOR CAUSE OEFUNCOER
_
SUSPENDED SECURITY CLEARANCE OR OTHER ADVERSE ACTION
_ REGARDING SECURITY CLEARANCE
DISCHARGE PURSUANT TO AR 635-200 (ENLISTEDyAR 800-8-24 (OFFICER)
Regulation Chapter Characterization Discharge Date

_
3
MI c. NONJUDI MAL PUNISHMENT (Artiste 15, ()CMJ) (ATTACH COPY OF ARTICLE 15
SUMMARIZED _ FIELD GRADE_ GCMCA IMPOSED
COMPANY GRADE

GENERAL OFFICER IMPOSED
• d JUDICIAL al subject was tried by court-martial attach a copy of the court-martial order giving findings and sentences)
—

SUMMARY COURT MARTIAL GENERAL COURT-MARTIAL
SPECIAL COURT-MARTIAL

CIVILIAN OR MAGISTRATE CRIMINAL COURT _
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13. JUDIC FINDINGS
GUILTY DISMISSED
NOT GUILTY OTHER (For example, guilty of a lesser included offense. Explain in Remarks.)

14. RESULTANT SENTENCES, PUNISHMENTS. OR INNISTRATIVE ACTION
_
a. REPRIMAND b. ADMONITION — (1) ORAL • (2) IN WRITING

—
c. DETENTION O. FORFEITURE --e. FINED35 /3MONTHS

—
I. REDUCED FROM3TO3 g. EXTRA DUTY FOR3DAYS3h. RESTRICTED FOR3DAYS
I. CORRECTIONAL CUSTODY FOR3DAYS3J. CONFINED3YEARS3MONTHS
k. SEPARATION:3PUNITIVE DISCHARGE OTHER Type3 Chapter;3 Characterization*3 Effective Date:

nI. OTHER (For example, suspension of driving privileges. Explain In Remarks.)
15. REMARKS
.

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( bf,„0 1 ,s , . t
,
. -

tea. T3ME AND GRADE OF COMMANDING OFFICER
LTe.,
.

160. SI3-16c. DATE OF REPORT (YYYYMAIDD)

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