DA Form 1704-r "Parole Statement"

What Is DA Form 1704-r?

This is a military form that was released by the U.S. Department of the Army (DA) on February 1, 1972. The form, often mistakenly referred to as the DD Form 1704-r, 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:

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  • The latest version available from the Army Publishing Directorate;
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Download an up-to-date fillable DA Form 1704-r down below in PDF format or browse hundreds of other DA Forms stored in our online database.

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Download DA Form 1704-r "Parole Statement"

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PAROLE STATEMENT
For use of this form, see AR 190-47; the proponent agency is the PMG.
SECTION I
NAME OF DISCIPLINARY BARRACKS
TO: THE COMMANDANT
TYPED NAME OF PRISONER
SSN
SECTION II
UNDER REGULATIONS I BECOME ELIGIBLE FOR
INITIAL
ANNUAL PAROLE
CONSIDERATION ON
.
I
DESIRE
DO NOT DESIRE PAROLE FOR THE FOLLOWING REASONS:
SECTION III
MY PLAN FOR THE FUTURE IS AS FOLLOWS: (State fully where and with whom you will live.)
PROPOSED PAROLE ADVISOR: (Give complete name and address.)
PROPOSED EMPLOYER: (Give complete name, and nature of employment.)
SECTION IV
DATE
SIGNATURE OF PRISONER
REGISTER NUMBER
SIGNATURE
TYPED NAME AND TITLE OF WITNESS
DA FORM 1704-R, 1 FEB 1972
EDITION OF 1 JAN 70 WILL BE USED.
APD LC v1.02ES
PAROLE STATEMENT
For use of this form, see AR 190-47; the proponent agency is the PMG.
SECTION I
NAME OF DISCIPLINARY BARRACKS
TO: THE COMMANDANT
TYPED NAME OF PRISONER
SSN
SECTION II
UNDER REGULATIONS I BECOME ELIGIBLE FOR
INITIAL
ANNUAL PAROLE
CONSIDERATION ON
.
I
DESIRE
DO NOT DESIRE PAROLE FOR THE FOLLOWING REASONS:
SECTION III
MY PLAN FOR THE FUTURE IS AS FOLLOWS: (State fully where and with whom you will live.)
PROPOSED PAROLE ADVISOR: (Give complete name and address.)
PROPOSED EMPLOYER: (Give complete name, and nature of employment.)
SECTION IV
DATE
SIGNATURE OF PRISONER
REGISTER NUMBER
SIGNATURE
TYPED NAME AND TITLE OF WITNESS
DA FORM 1704-R, 1 FEB 1972
EDITION OF 1 JAN 70 WILL BE USED.
APD LC v1.02ES