DA Form 3499 Application for Relief From Court-Martial Findings and/Or Sentence Under the Provisions of Title 10, United States Code, Section 869

DA Form 3499 - also known as the "Application For Relief From Court-martial Findings And/or Sentence Under The Provisions Of Title 10, United States Code, Section 869" - 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 3499 - was last revised on July 1, 2014. Download an up-to-date fillable PDF version of the DA 3499 below or request a copy through the chain of command.

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DOCKET NUMBER
APPLICATION FOR RELIEF FROM COURT-MARTIAL FINDINGS AND/OR SENTENCE
UNDER THE PROVISIONS OF TITLE 10, UNITED STATES CODE, SECTION 869
For use of this form, see AR 27-10; the proponent agency is TJAG.
(For TJAG Use)
(Read Instructions on Reverse BEFORE Completing Application)
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
10 USC 869 AND 3037.
PRINCIPAL PURPOSES:
To appeal your court-martial findings and/or sentence to The Judge Advocate General under the provisions of Article 69(b), UCMJ.
ROUTINE USES:
To evaluate your appeal and aid in determining whether the relief sought is appropriate.
DISCLOSURE:
Disclosure of the requested information is voluntary. Failure to provide complete information may delay evaluation of your appeal
and may result in incomplete evaluation of your appeal.
1. NAME OF CONVICTED PERSON (Last, First, MI)
2. PRESENT GRADE OR STATUS
3. DATE OF TRIAL
4. PLACE OF TRIAL
5. COMMAND CONVENING COURT-MARTIAL
6. TYPE OF COURT-MARTIAL
SUMMARY
SPECIAL
7. OFFENSE(S) CHARGED (Article(s) and brief description of offense(s))
8. PLEA(S)
9. FINDINGS OF THE COURT-MARTIAL, SENTENCE ADJUDGED, AND LATER MODIFICATIONS, IF ANY:
10. I BELIEVE RELIEF IN THE ABOVE NAMED COURT-MARTIAL IS JUSTIFIED BECAUSE: (State fully the reasons you believe relief should be granted.
The reasons must relate to at least one of the five grounds set forth in Article 69(b), UCMJ.)
11. RELIEF REQUESTED
12. NAME AND ADDRESS OF COUNSEL ASSISTING WITH APPLICATION, IF ANY: (Include ZIP Code)
PREVIOUS EDITION IS OBSOLETE.
DA FORM 3499, JUL 2014
Page 1 of 2
APD LC v1.00
DOCKET NUMBER
APPLICATION FOR RELIEF FROM COURT-MARTIAL FINDINGS AND/OR SENTENCE
UNDER THE PROVISIONS OF TITLE 10, UNITED STATES CODE, SECTION 869
For use of this form, see AR 27-10; the proponent agency is TJAG.
(For TJAG Use)
(Read Instructions on Reverse BEFORE Completing Application)
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
10 USC 869 AND 3037.
PRINCIPAL PURPOSES:
To appeal your court-martial findings and/or sentence to The Judge Advocate General under the provisions of Article 69(b), UCMJ.
ROUTINE USES:
To evaluate your appeal and aid in determining whether the relief sought is appropriate.
DISCLOSURE:
Disclosure of the requested information is voluntary. Failure to provide complete information may delay evaluation of your appeal
and may result in incomplete evaluation of your appeal.
1. NAME OF CONVICTED PERSON (Last, First, MI)
2. PRESENT GRADE OR STATUS
3. DATE OF TRIAL
4. PLACE OF TRIAL
5. COMMAND CONVENING COURT-MARTIAL
6. TYPE OF COURT-MARTIAL
SUMMARY
SPECIAL
7. OFFENSE(S) CHARGED (Article(s) and brief description of offense(s))
8. PLEA(S)
9. FINDINGS OF THE COURT-MARTIAL, SENTENCE ADJUDGED, AND LATER MODIFICATIONS, IF ANY:
10. I BELIEVE RELIEF IN THE ABOVE NAMED COURT-MARTIAL IS JUSTIFIED BECAUSE: (State fully the reasons you believe relief should be granted.
The reasons must relate to at least one of the five grounds set forth in Article 69(b), UCMJ.)
11. RELIEF REQUESTED
12. NAME AND ADDRESS OF COUNSEL ASSISTING WITH APPLICATION, IF ANY: (Include ZIP Code)
PREVIOUS EDITION IS OBSOLETE.
DA FORM 3499, JUL 2014
Page 1 of 2
APD LC v1.00
14. PRESENT ADDRESS OF APPLICANT (Include ZIP Code) (Forward
13. ENCLOSED ARE:
notification of any change)
A COPY OF COURT-MARTIAL
SWORN AFFIDAVITS,
ORDER(S) PROMULGATING
DOCUMENTS, OR OTHER
RESULT OF TRIAL, AND
MATTERS IN SUPPORT
LATER MODIFICATION(S), IF
OF APPLICATION
ANY
15. OATH OR AFFIRMATION: (See instruction 5)
I DO SOLEMNLY [SWEAR] [AFFIRM AND DECLARE] THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE STATEMENTS CONTAINED IN THIS APPLICATION
(including accompanying matters submitted) ARE TRUE [SO HELP ME GOD]. I MAKE THIS ASSERTION UNDER THE PAINS AND PENALTIES OF FALSE SWEARING.
(Title 18 U.S. Code, Section 1001 provides a penalty of not more than $10,000 fine, five years imprisonment, or both, for knowingly making false statements in connection with this
application.)
SIGNATURE OF APPLICANT
NAME OF APPLICANT
SWORN TO BEFORE ME AND SUBSCRIBED IN MY PRESENCE THIS
DAY OF
20
(Seal)
INSTRUCTIONS
(Read ALL Instructions Before Completing Form)
1. Application for relief from the findings or sentence, or both,
6. Applicant's entry in Item 11 should describe the reasons for the request
of a court-martial case which has been finally reviewed, but has
for relief. Relevant facts which support the applicant's contentions should be
not been reviewed by the United States Army Court of Criminal
included. Legal authorities may be presented in this section, or may be
Appeals. Army Regulation 27-10, which is summarized in these
instructions.
attached in the form of a legal brief, if applicant desires. Other matters
tending to support applicant's allegations of error or impropriety, including
2. Article 69(b) of the Uniform Code of Military Justice (Title
10, US Code, Section 869(b)) provides that: "The findings or
but not limited to, sworn affidavits, official records, and other documents,
sentence, or both, in a court-martial case not reviewed under
may be attached. The applicant bears the burden of establishing an alleged
subsection (a) or under section 866 of this title (Article 66)
impropriety. Unsupported allegations of matters outside the record of trial
may be modified or set aside, in whole or in part, by the Judge
Advocate General on the ground of newly discovered evidence,
will seldom be sufficient to warrant relief.
fraud on the court, lack of jurisdiction over the accused or the
offense, error prejudicial to the substantial rights of the accused,
7. A copy of the court-martial order (or the record of trial in the case of
or the appropriateness of the sentence."
a summary court-martial) promulgating the findings, sentence, and action
3. Relief is authorized only when (1) the post-trial process of
of the convening authority in the case, and a copy of any later modifying
legal review of the case has been completed, and (2) at least one
order(s), if available to the applicant, should be submitted with the application.
of the five grounds set forth in paragraph 2 above has been
established to the satisfaction of The Judge Advocate General.
8. A copy of the record of trial in cases other than summary courts-martial
Application for relief on the ground of sentence appropriateness
normally will not be considered if the application is based solely
should not be submitted.
on the quality of the behavior or duty performance of the
9. If the applicant is a member of the command which convened the court
convicted person after trial, or on any evidence of personal
hardship not admitted at trial. For other avenues of relief, see
-martial, or of a unit within the same general court-martial jurisdiction, the
Title 10, U.S. Code, Section 874 (Article 74, UCMJ) or 32 CFR
application should be submitted through the Office of the Staff Judge
581.3 (Army Board for the Correction of Military Records).
Advocate of that general court-martial jurisdiction. In all other cases,
4. Except as provided in this paragraph, the application must be
applications will be submitted directly to Office of The Judge Advocate
signed by the individual convicted by court-martial. In those
General, ATTN: Criminal Law Division, 2200 Army Pentagon, Washington
cases where the individual is deceased, incapable of making ap-
D.C. 20310-2200 and must be received on or before the last day of the
plication, or whose whereabouts are unknown, The Judge
2-year period beginning on the date the sentence was approved by the
Advocate General may permit application to be made by such
person as he/she determines to be competent and suitable, and
convening authority. Failure to file within the prescribed time may be excused
to have a proper interest therein, including, but not limited to,
by The Judge Advocate General of good cause established by the applicant.
a spouse, parent, or relative of the person convicted by court-
martial substantially affected as a result of the findings or
10. Submit only the original of this form.
sentence, or both, which the applicant maintains should be
11. Type, or print all entries in ink.
vacated or modified. If application is not signed by the indi-
vidual convicted, full explanation should be made and attached.
12. If space allotted is insufficient, attach additional sheet(s), indicating item
number continued thereon.
5. The application must be submitted under oath or affirmation
executed before an official authorized to administer oaths. A
13. Complete all items; if inapplicable, enter "None".
notary public is usually authorized to perform this function.
Military personnel on active duty may execute the application
14. Applicant should send notice of change in address while application is
before a judge advocate or other officer authorized by Article
pending to The Judge Advocate General at the address shown in instruction 9
136(a) of the Uniform Code of Military Justice to administer oaths.
above.
Knowingly making a false statement in connection with an
application for relief can be punished by a $10,000 fine, five years
15. Applicant will be notified of receipt of application by The Judge Advocate
imprisonment, or both.
General, and the result of review, when completed.
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DA Form 3499, JUL 2014
APD LC v1.00

Download DA Form 3499 Application for Relief From Court-Martial Findings and/Or Sentence Under the Provisions of Title 10, United States Code, Section 869

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