PerFORM Communicator File Packet v 1.00 \c:\formflow\forms\Ah'>OA/ '>J,W>R'>Cr<'>dd0200.frz\forms\dd0200.frz5ي$$E0dd0200.fdbtemp\df000002\dd0200.fdb6S@ ;dd0200.dbftemp\df000002\dd0200.dbf6SCdd0200.dbttemp\df000002\dd0200.dbt6Sa\Tdd0200.fdstemp\df000002\dd0200.fds6Sy\Financial Liability Investigation of Property Losswhs/dior175C:\DOCUME~1\SHERMA~1\MYDOCU~1\ETM'S\FORMPA~1\DD-200.FPKC:\WINDOWS\TEMP\KFinancial Liability Investigation of Property Loss000?0"x 3,3"3 3n@3*Q3|;ࡱ> Root EntryRoot Entry` )HContentshOccDataSummaryInformation( M  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~FBMacrosGeneralMacroStream( 07-@KGOh+'0L  0 < H T `lt|LLL3Financial Liability Investigation of Property Loss whs/dior OSD WHS DIOR175@3@W ЈO@fv@ʑG0K48DH xP#  "2 -%000000- -%000P0P00-.- "Univers  "|w|wgw  " -- R2 D2FINANCIAL LIABILITY INVESTIGATION OF PROPERTY LOSS            "System  --.- "Univers6 u|w|wgw6 u -- '2 `CPRIVACY ACT STATEMENTS       - -p-.- "Univers  #|w|wgw  # -"Univers6 v|w|wgw6 v -- 2 y> AUTHORITY:"Univers  $|w|wgw  $ -- L2 y. 10 USC 2775; DoD Directive 7200.11; EO 9397."Univers6 w|w|wgw6 w -"Univers  %|w|wgw  % - "Univers6 x|w|wgw6 x - - (2 >PRINCIPAL PURPOSE(S): "Univers  &|w|wgw  & - - <2 # To officially report the facts andt"Univers6 y|w|wgw6 y - - g2 >@circumstances supporting the assessment of financial charges for  "Univers  '|w|wgw  ' - - i2 >Athe loss, damage, or destruction of DoD-controlled property. The "Univers6 z|w|wgw6 z -- c2 >=purpose of soliciting the SSN is for positive identification.--.- "Univers  (|w|wgw  ( -"Univers6 {|w|wgw6 { -- 2 yROUTINE USE(S):"Univers  )|w|wgw  ) -- 2 y None."Univers6 ||w|wgw6 | -"Univers  *|w|wgw  * -"Univers6 }|w|wgw6 } -- 2  DISCLOSURE:"Univers  +|w|wgw  + -- I2 , Voluntary; however, refusal to explain the "Univers6 ~|w|wgw6 ~ -- a2 <circumstances under which the property was lost, damaged, or   "Univers  ,|w|wgw  , -- g2 @destroyed may be considered with other factors in determining if  "Univers6 |w|wgw6  -- L2 .an individual will be held financially liable. - -%0  00-.- "Univers  -|w|wgw  - -- "2 51. DATE INITIATED"Univers6 |w|wgw6 -- 2 (YYYYMMDD)- -% 66  -.- "Univers  .|w|wgw  . -- 72  2. INQUIRY/INVESTIGATION NUMBER "Univers6 |w|wgw6 -- -%666-.- "Univers  /|w|wgw  / -- *2 ;3. DATE LOSS DISCOVERED"Univers6 |w|wgw6 -"Univers  0|w|wgw  0 --  2 ; "Univers6 |w|wgw6 -- 2 I (YYYYMMDD) -#@ J (@  - -%000-.- "Univers  2|w|wgw  2 -- (2 54. NATIONAL STOCK NO."Univers6 |w|wgw6 -- -%-.- "Univers  3|w|wgw  3 -- %2 5. ITEM DESCRIPTION "Univers6 |w|wgw6 -- 2  - -%66-.- "Univers  4|w|wgw  4 -- 2  6. QUANTITY"Univers6 |w|wgw6 -- -%666-.- "Univers  5|w|wgw  5 -- 2 ; 7. UNIT COST"Univers6 |w|wgw6 - -  -%-.- "Univers  6|w|wgw  6 - - 2 8. TOTAL COST"Univers6 |w|wgw6 -!-!-.- "Univers  7|w|wgw  7 -!"Univers6 |w|wgw6 -"- F2 5*9. CIRCUMSTANCES UNDER WHICH PROPERTY WAS    -#@ J H(@  FormFlow     FormFlow 2.0577 XLOSTt@ GO!GO GOGO KHOHOPress the space bar to enter an X in this box and/or tab to the next box. GOGO XDAMAGED@ >IO" >IO TIOTIO XDESTROYED@ FINDINGS @. 1ORGADDR15 @. 5XOBJECTION@ O!<O OO KOOPress the space bar to enter an X in this box and/or tab to the next box. OO XNOOBJECT@ 2O$=2O HOHO ORGADDR17 @. EDATEINIT @. INQINVNO @. LOSSDATE @. NSNult @. ITEMDESC @. QUANTITY@. UNITCOSTCB. TOTALCOST. 'PnO'PnO[QUANTITY]*[UNITCOST] O OOOQUANTITY*nUNITCOSTL O O@@ 0NAME11 @. DSN11N11 @. SIGDATE11@. NAME12 @. DSN12N12 @. SIGDATE12 @. NAME13 @. "DSN13N13 @. #SIGDATE13 @. %NAME14 @. -DSN14N14 @. .SIGDATE14 @. 0LOSSAMTCB. 2MONTHLYPAYCB. 3RECOMMLIABCB. 4NAME15 @. 6DSN15N15 @. 7DATESUBM @. 8DATEAPPT @. 9SIGDATE15 @. ;NAME16 @. ?SSN16t @. @DSN16N16 @. ASIGDATE16 @. CDOCNOt @. DNAME17 @. FDSN17N17 @. GSIGDATE17 @. Ixnalegrev@ j'P$+j'P 'P'P sign11 @. sign12 @. sign13 @. $sign14 @. /sign15 @. :sign16 @. Bsign17 @. HdBASECourier1Arial"Times New RomanTimes New RomanArial"Univers (WN)"CG Times (WN)Univers (W1)"CG Times (W1)Univers"CG Times111Ya  $ָų\KhC4B?)w#ƇWWN%ƇWWg#C@LJWAK%WWh W7* 4g#Iw#Iw#44: 4w#Wȴ -OnƇWƒHO^O "O5ƇWDD0200.FRZ5OOO#T-1jJ8c|Ԕp()\KhC111\KhC11111"!111R"!81a 'P6O'POFINANCIAL LIABILITY INVESTIGATION OF PROPERTY LOSS)R!k8qI R'PTOR'PTOPRIVACY ACT STATEMENTs N ;kl(I 2'PLO 2'PO AUTHORITY:  10 USC 2775; DoD Directive 7200.11; EO 9397.  PRINCIPAL PURPOSE(S):   To officially report the facts and circumstances supporting the assessment of financial charges for the loss, damage, or destruction of DoD-controlled property. The purpose of soliciting the SSN is for positive identification.kl'I 'P&O 'P&O ROUTINE USE(S):  None.  DISCLOSURE:  Voluntary; however, refusal to explain the circumstances under which the property was lost, damaged, or destroyed may be considered with other factors in determining if an individual will be held financially liable.1l~"1a  DATEINIT 'P,&O'P&O 1. DATE INITIATED  (YYYYMMDD) ldI~1a  INQINVNO 'P%DO'PDO 2. INQUIRY/INVESTIGATION NUMBER dIl~1a  LOSSDATE 'P;$EO'P$EO 3. DATE LOSS DISCOVERED   (YYYYMMDD) 1~p"1a  NSN 'PO'PO 4. NATIONAL STOCK NO. p~,H1a  ITEMDESC 'PĖO'PĖO 5. ITEM DESCRIPTION ,~dIH1a  QUANTITY 'P4O'P4O 6. QUANTITY dI~1a  UNITCOST 'P'P'P'P 7. UNIT COST ~1a  TOTALCOST 'P'P'P'P 8. TOTAL COST 73g!G3ÇW4%w#LOWW4Ķ O'PW-^LJWv!-0Ov!W.-O^LJWW5TćO7373Zd:@ָ G3ľ1*73g!G3ÇW4%w#LOWW4Ķ 1+:"  z'Pv'Pz'P'P 9. CIRCUMSTANCES UNDER WHICH PROPERTY WAS  (X one) (Attach additional pages as necessary),)H\1 XLOST  dI)\ @'PDO@'PDOLOSTdI(g)1 XDAMAGED  (g) 'PO'PODAMAGED`)1 XDESTROYED  `) 'PO'PODESTROYED1+:k"  CIRCUMSTNC  1k،" 1a  x'P4Ox'P4O 10. ACTIONS TAKEN TO CORRECT CIRCUMSTANCES REPORTED IN BLOCK 9 AND PREVENT FUTURE OCCURRENCES  (Attach additional pages as necessary)1،s" -1a   CORRACTION  1s"- 90a n'P1n'P11. INDIVIDUAL COMPLETING BLOCKS 1 THROUGH 101lG"9O0  ('Pp('P a. ORGANIZATIONAL ADDRESS  (Unit Designation, Office Symbol, Base, State/Country, Zip Code)1lG!"Op0   ORGADDR11  lG{9O0  NAME11 \'P@\'P b. TYPED NAME  (Last, First, Middle Initial) {9O0  DSN11N11 n'Pn'P c. DSN NUMBER lG{!Op0 sign11 'P'P d. SIGNATURE {!Op0  SIGDATE11 'P'P e. DATE SIGNED 1!!"ppa1!22"pW|0 'P'P12.  (X one)!22Wpk|0 XRESPOFFCR  !|22kp.|0 6'P/6'PRESPONSIBLE OFFICER (PROPERTY RECORD ITEMS)|!@22.pB|0 XREVAUTH  @!42Bp|0 'P.'PREVIEWING AUTHORITY (SUPPLY SYSTEM STOCKS)122pc"|0  t'PNt'P a. NEGLIGENCE OR ABUSE EVIDENT/ SUSPECTED  (X one)1c`OVt"60 XYESNEGLG  cVtWk0 XNONEGLG  `OcVt6W0 'P'PYEScpVtk0 'P'PNOp22B|  'P 'Pb. COMMENTS/RECOMMENDATIONSpBVt0  COMMENTS12  1VtlGh"0  D'PpD'P c. ORGANIZATIONAL ADDRESS  (Unit Designation, Office Symbol, Base, State/Country, Zip Code)1hlG"0   ORGADDR12  lGVt{h0  NAME12 V'P@V'P d. TYPED NAME  (Last, First, Middle Initial) 73g!G3ÇW4%w#LOWW4Ķ O'PW-^LJWv!-0Ov!W.-O^LJWW5TćO7373Zd:@ָ G3ľ1*73g!G3ÇW4%w#LOWW4Ķ {Vth0  DSN12N12 h'Ph'P e. DSN NUMBER lGh{0 sign12 N'PN'P f. SIGNATURE {h0  SIGDATE12 2'P2'P g. DATE SIGNED 1"a1lG"0  'P 'P13. APPOINTING AUTHORITY1p"0  'P/'P a. RECOMMENDATION   (X one)1`O' "6 0 XAPPR13