DA Form 1134-R Request for Withdrawal of Personal Property (Lra)

DA Form 1134-R or the "Request For Withdrawal Of Personal Property (lra)" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 1134-R - was last revised on April 1, 1986. Download an up-to-date fillable DA Form 1134-R down below in PDF-format or look it up on the Army Publishing Directorate website.

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DATE
REQUEST FOR WITHDRAWAL OF PERSONAL PROPERTY
For use of this form, see AR 210-174; the proponent agency is USAFAC.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY: Title 10, USC, Sec 3012.
PRINCIPAL PURPOSE: To verify information given on request for withdrawal of personal property.
ROUTINE USE: Information is used to verify withdrawal of property.
DISCLOSURE & EFFECT: VOLUNTARY. If information is not provided, request cannot be completed.
(Name of prisoner and register or service number)
TO:
FROM:
Custodian of Personal Deposit Fund
I hereby request authorization to withdraw the following personal property
for my personal use: (List individual items and give full explanation for this request.)
(Signature of Prisoner)
POSTED ON DA FORM
DATE
WITHDRAWAL
1132-R
APPROVED
WITHDRAWAL
DISAPPROVED
(Signature of Custodian)
The following items of personal property were received by me:
DATE
SIGNATURE OF PRISONER
APD LC v1.01ES
DA FORM 1134-R, APR 1986
REPLACES DA FORM 1134, 1 JAN 61, WHICH MAY BE USED UNTIL EXHAUSTED
DATE
REQUEST FOR WITHDRAWAL OF PERSONAL PROPERTY
For use of this form, see AR 210-174; the proponent agency is USAFAC.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY: Title 10, USC, Sec 3012.
PRINCIPAL PURPOSE: To verify information given on request for withdrawal of personal property.
ROUTINE USE: Information is used to verify withdrawal of property.
DISCLOSURE & EFFECT: VOLUNTARY. If information is not provided, request cannot be completed.
(Name of prisoner and register or service number)
TO:
FROM:
Custodian of Personal Deposit Fund
I hereby request authorization to withdraw the following personal property
for my personal use: (List individual items and give full explanation for this request.)
(Signature of Prisoner)
POSTED ON DA FORM
DATE
WITHDRAWAL
1132-R
APPROVED
WITHDRAWAL
DISAPPROVED
(Signature of Custodian)
The following items of personal property were received by me:
DATE
SIGNATURE OF PRISONER
APD LC v1.01ES
DA FORM 1134-R, APR 1986
REPLACES DA FORM 1134, 1 JAN 61, WHICH MAY BE USED UNTIL EXHAUSTED

Download DA Form 1134-R Request for Withdrawal of Personal Property (Lra)

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