(Place) , 19
Name, etc., of accused
(Give last name, first name, and middle initial in that order,
followed by serial number, grade, company, regiment, arm or service, or by other appropriate
description of accused. Alias names,etc., to follow in same manner.)
Age ________. Pay, $________ per month. Allotments to dependents, $________
(Base pay plus pay for length of service)
per month. Government insurance deduction, $________ per month.
Data as to service:
(As to each terminated enlistment, give including dates of service
and organization in which serving at termination. As to current enlistment, give the ini-
tial date and term thereof. Give similr data as to service not under an enlistment)
Data as to witnesses, etc.:
(Give names, addresses, and note if for accused. List documentary evidence and note where each item thereof may be found)
Data as to restraint of accused:
(Give date, place, and initial date of any restraint of accused)
(End of page 1 of Charge Sheet)
CHARGE: Violation of the ________ Article of War.
(End of page 2 of Charge Sheet)
(Signature of accuser)
(Grade, organization, and branch)
Before me, the undersigned, authorized by law to administer oaths in cases of this character, personally appeared the above-named accuser this ________ day of ________, 19__, and made oath that he is a person subject to military law and that he personally signed the foregoing charges and specifications, and further that he has personal knowledge of the matters set forth in specifications (Indicate by specification and charge numbers): ; and * has investigated the matters set forth in specifications (Indicate by specification and charge numbers): ; and that the same are true in fact, to the best of his knowledge and belief.
(Rank and organization)
(Official character, as summary
court, notary public, etc.)
NOTES.--At (*) strike out words not applicable.
If the accuser has personal knowledge of the facts stated in one or more specifications or parts thereof, and his knowledge as to other specifications or parts thereof is derived from investigation of the facts, the form of the oath will be varied accordingly. In no case will he be permitted to state alternatively, as to any particular charge or specification, that he either has personal knowledge or has investigated.
If the oath is administered by a civil officer having a seal, his official seal should be affixed.
Referred for trial to
(Rank, name, and organization of summary court, or trial judge
advocate) (Summary) (Trial judge advocate of special or general)
pointed by paragraph ________________, Special Orders No. ________________, Headquarters ________________
(Command or order) (Rank and name of commanding officer)
(End of page 3 of Charge Sheet)
I have served a copy hereof on (each of) the above-named accused, this day of , 19__.
(Signature) , Trial Judge Advocate.
(Rank and organization)
(Space for use where trial is by summary court)
CASE No. __________
SPECIFICATIONS AND CHARGES PLEAS FINDINGS SENTENCE OR ACQUITTAL AND REMARKS
Place ____________________, Date ____________________, 19____
Summmary Court. Headquarters
(Signature, rank, and organization) (Place and date)
(Action of reviewing authority)
(Signature, rank, and organization)
(End of page 4 of Charge Sheet)
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