DA Form 5109 Request to Superior to Exercise Article 15, UCMJ, Jurisdiction

DA Form 5109 or the "Request To Superior To Exercise Article 15, Ucmj, Jurisdiction" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 5109 - was last revised on September 1, 2002. Download an up-to-date fillable DA Form 5109 down below in PDF-format or look it up on the Army Publishing Directorate website.

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REQUEST TO SUPERIOR TO EXERCISE ARTICLE 15, UCMJ, JURISDICTION
For use of this form, see AR 27-10; the proponent agency is OTJAG
THRU:
TO:
(Include ZIP Code)
(Include Zip Code)
(Check appropriate block and complete narrative)
It has been reported
The enclosed file indicates
that on or
about
at
(Date)
(Place)
NOTE: Insert the name and organization of the individual concerned and the nature of the alleged misconduct in the
form of a clear and concise statement of an offense that constitutes conduct punishable under the UCMJ and the
article of the UCMJ violated.
2. I recommend that you exercise your authority under the provisions of Article 15, UCMJ, in the disposition of this case.
3. Enclosures: (List)
NAME, GRADE, AND ORGANIZATION OF COMMANDER
SIGNATURE
DATE (YYYYMMDD)
DA FORM 5109-R, NOV 82, IS OBSOLETE.
APD LC v2.01ES
DA FORM 5109, SEP 2002

Download DA Form 5109 Request to Superior to Exercise Article 15, UCMJ, Jurisdiction

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