DA Form 4139-r "Application for Loan (Civilian Welfare Fund)"

What Is DA Form 4139-r?

This is a military form that was released by the U.S. Department of the Army (DA) on January 1, 1974. The form, often mistakenly referred to as the DD Form 4139-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:

  • 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 4139-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 4139-r "Application for Loan (Civilian Welfare Fund)"

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LOCATION
APPLICATION FOR LOAN (Civilian Welfare Fund)
For use of this form, see AR 215-5; the proponent agency is USAFAC
I hereby apply for an emergency loan of $
for a period of
months to be
repaid in
monthly installments of $
each; I prefer the first payment to fall due
. I desire this loan for the following purpose:
on
FULL EXPLANATION
All of the above statements made are true and complete and submitted for the purpose of obtaining this loan.
SIGNATURE OF APPLICANT
ADDRESS OF APPLICANT
DATE
ORGANIZATIONAL UNIT
NAME OF IMMEDIATE SUPERVISOR AND TELEPHONE NUMBER
TITLE OF APPROVING AUTHORITY
SIGNATURE
DATE APPROVED
DA FORM 4139-R, JAN 1974
APD LC v1.01ES
LOCATION
APPLICATION FOR LOAN (Civilian Welfare Fund)
For use of this form, see AR 215-5; the proponent agency is USAFAC
I hereby apply for an emergency loan of $
for a period of
months to be
repaid in
monthly installments of $
each; I prefer the first payment to fall due
. I desire this loan for the following purpose:
on
FULL EXPLANATION
All of the above statements made are true and complete and submitted for the purpose of obtaining this loan.
SIGNATURE OF APPLICANT
ADDRESS OF APPLICANT
DATE
ORGANIZATIONAL UNIT
NAME OF IMMEDIATE SUPERVISOR AND TELEPHONE NUMBER
TITLE OF APPROVING AUTHORITY
SIGNATURE
DATE APPROVED
DA FORM 4139-R, JAN 1974
APD LC v1.01ES