DA Form 1704-r Parole Statement

DA Form 1704-r - also known as the "Parole Statement" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 1704-r - was last revised on February 1, 1972. Download an up-to-date fillable PDF version of the DA 1704-r below or request a copy through the chain of command.

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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

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