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Get Ssa 827 1985-2024

70 Indianapolis IN 46249-0865 Commanding Officer U.S. Navy Finance Center Anthony J. Celebrezze Federal Building Cleveland OH 44199-2055 HQAFAFC Code CC Denver CO 80279-4000 USMC Finance Center Code SEC Kansas City MO 64197-0001 USCG Pay and Personnel Center 444 S.E. Quincy Street Topeka KS 66683-0000 DD Form 827 MAR 85 Previous editions are obsolete. Form for use of service members former service members or legal representatives of incompetent members in claiming arrears of pay etc. believed to be due. INSTRUCTIONS APPLICATION FOR ARREARS IN PAY FOR SERVICE IN THE ARMED FORCES OF THE UNITED STATES SUBMIT IN TRIPLICATE* TYPE OR PRINT. Claimant fills out Items 1-7. Disbursing/Finance Officer fills out Item 8. PRIVACY ACT STATEMENT AUTHORITY PRINCIPAL PURPOSE ROUTINE USES DISCLOSURE GAO Manual Title 2 Section 5 Revised 1978 and 5 U*S* Code 301. Supports claim to Finance Center for pay which cannot be supported by local records. Claims are submitted because local records are incomplete or member is separated or will be separated before missing information can be obtained or supporting documents are lost or legislation or administrative decision creates retroactive entitlement which cannot be paid locally. Voluntary. Claim initiated by member is only basis for payment. WARNING WHOEVER MAKES OR PRESENTS TO ANY PERSON OR OFFICER IN THE CIVIL MILITARY OR NAVAL SERVICE OF THE UNITED STATES OR ANY DEPARTMENT OR AGENCY THEREOF ANY CLAIM UPON OR AGAINST THE UNITED STATES OR ANY DEPARTMENT OR AGENCY THEREOF KNOWING SUCH CLAIM TO BE FALSE FICTITIOUS OR FRAUDULENT WILL BE FINED NOT MORE THAN 10 000 OR IMPRISONED NOT MORE THAN FIVE YEARS OR BOTH. 62 Stat. 698 18 U*S* Code 287 1. CLAIMANT DATA a* NAME Last First Middle Initial e. SIGNATURE b. SOCIAL SECURITY NUMBER c* PAY GRADE d. RANK f* DATE SIGNED g. MAILING ADDRESS Street PO Box City State Zip Code YYMMDD 2. PERIOD FOR WHICH ARREARS ARE BELIEVED TO BE DUE FROM THE U*S* b. TO YYMMDD a* FROM YYMMDD 4. LAST DATE ENLISTED/ENTERED ON ACTIVE DUTY YYMMDD 3. CLAIMANT SERVED IN X one ARMY 5. LAST DATE DISCHARGED/RELEASED FROM ACTIVE DUTY YYMMDD NAVY AIR FORCE MARINE CORPS 6. PLACE OF DISCHARGE City State COAST GUARD 7. FACTS AND CIRCUMSTANCES ON WHICH CLAIM IS BASED State in sufficient detail to give a clear understanding. Continue on reverse side if additional space is needed* 8. DISBURSING/FINANCE OFFICER Complete only if claimant is on active duty. Continue on reverse side if additional space is needed* I hereby certify that I have not and will not pay any portion of this claim for the following reasons b. UNIT/COMMAND NAME d. DATE SIGNED YYMMDD e. DISBURSING OFFICER SYMBOL NO. ATTACH ALL AVAILABLE DOCUMENTARY EVIDENCE IN SUPPORT OF CLAIM AND MAIL TO Commander U*S* Army Finance Acctg Center Dept. Claimant fills out Items 1-7. Disbursing/Finance Officer fills out Item 8. PRIVACY ACT STATEMENT AUTHORITY PRINCIPAL PURPOSE ROUTINE USES DISCLOSURE GAO Manual Title 2 Section 5 Revised 1978 and 5 U*S* Code 301. Supports claim to Finance Center for pay which cannot be supported by local records. Claims are submitted because local records are incomplete or member is separated or will be separated before missing information can be obtained or supporting documents are lost or legislation or administrative decision creates retroactive entitlement which cannot be paid locally. .

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