DA Form 2804 "Crime Records Data Reference"

What Is DA Form 2804?

This is a military form that was released by the U.S. Department of the Army (DA) on January 1, 1980. The form, often mistakenly referred to as the DD Form 2804, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

Form Details:

  • A 1-page document available for download in PDF;
  • The latest version available from the Army Publishing Directorate;
  • Editable, free, and easy to use;

Download an up-to-date fillable DA Form 2804 down below in PDF format or browse hundreds of other DA Forms stored in our online database.

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Download DA Form 2804 "Crime Records Data Reference"

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(Last, First, Middle)
1. NAME
2. SUBJ STATUS CODE
3. GRADE
4. MCAC
5. SSN
(Yr, Mo, Day)
6. ALIASES/NICKNAMES
7. SEX
10. FORMER SVC NO.
11. DOB
* CODES
8. RACE
9. ETHNIC
12. POB
(City, State)
13. ROI/MPR
(Include Primary Offense Code)
15. OTHER OFFENSE CODES
14. SURVEY
CODE
17. STA-
16. ORGANIZATION AND STATION
20. DRUGS INVOLVEMENT
DATE
TION CODE
18. OPENED
19. CLOSED
21. OTHER INVOLVEMENT
22. FILE LOCATION
(Check appropriate box)
23.
24. DISPOSITION
25. DATE REPORTED
26. ACTION TAKEN
SUSPECT
SUBJECT
VICTIM
YES
NO
RACE
REMARKS
9
CUBAN
5
FILIPINO
S
LATINAMER
V
VIETNAMESE
R
RED
1
OTHHISPANIC
3
OTHASIAN
M
YELLOW
N
BLACK
8
ALEUT
E
MELANESIAN
7
ESKIMO
W
MICRONESIAN
C
WHITE
2
USCANINDIAN
L
POLYNESIAN
X
OTHER
Z
UNKNOWN
G
CHINESE
Q
OTHPACISLAND
ETHNIC
J
JAPANESE
X
OTHER
6
MEXICAN
K
KOREAN
Y
NONE
4
PUERTO RICAN
D
INDIAN
Z
UNKOWN
DA FORM 2804, JAN 1980
CRIME RECORDS DATA REFERENCE
EDITION OF 1 APR 77 IS OBSOLETE.
FOR USE OF THIS FORM, SEE AR 195-2, THE PROPONENT
AGENCY IS PMG.
APD LC v2.01
(Last, First, Middle)
1. NAME
2. SUBJ STATUS CODE
3. GRADE
4. MCAC
5. SSN
(Yr, Mo, Day)
6. ALIASES/NICKNAMES
7. SEX
10. FORMER SVC NO.
11. DOB
* CODES
8. RACE
9. ETHNIC
12. POB
(City, State)
13. ROI/MPR
(Include Primary Offense Code)
15. OTHER OFFENSE CODES
14. SURVEY
CODE
17. STA-
16. ORGANIZATION AND STATION
20. DRUGS INVOLVEMENT
DATE
TION CODE
18. OPENED
19. CLOSED
21. OTHER INVOLVEMENT
22. FILE LOCATION
(Check appropriate box)
23.
24. DISPOSITION
25. DATE REPORTED
26. ACTION TAKEN
SUSPECT
SUBJECT
VICTIM
YES
NO
RACE
REMARKS
9
CUBAN
5
FILIPINO
S
LATINAMER
V
VIETNAMESE
R
RED
1
OTHHISPANIC
3
OTHASIAN
M
YELLOW
N
BLACK
8
ALEUT
E
MELANESIAN
7
ESKIMO
W
MICRONESIAN
C
WHITE
2
USCANINDIAN
L
POLYNESIAN
X
OTHER
Z
UNKNOWN
G
CHINESE
Q
OTHPACISLAND
ETHNIC
J
JAPANESE
X
OTHER
6
MEXICAN
K
KOREAN
Y
NONE
4
PUERTO RICAN
D
INDIAN
Z
UNKOWN
DA FORM 2804, JAN 1980
CRIME RECORDS DATA REFERENCE
EDITION OF 1 APR 77 IS OBSOLETE.
FOR USE OF THIS FORM, SEE AR 195-2, THE PROPONENT
AGENCY IS PMG.
APD LC v2.01