DA Form 2569-R Attorney of Record Designation (Civilian and Individual Military Counsel)

DA Form 2569-R - also known as the "Attorney Of Record Designation (civilian And Individual Military Counsel)" - 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 2569-R - was last revised on September 1, 2009. Download an up-to-date fillable PDF version of the DA 2569-R below or request a copy through the chain of command.

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ATTORNEY OF RECORD DESIGNATION
(Civilian and Individual Military Counsel)
For use of this form, see AR 190-47; the proponent agency is DCS, G-1.
DATE
, Service No.
I,
Register Number
, have retained
an attorney whose address is
to represent me in the matter of
I request that said attorney be permitted to visit me and to communicate with me as necessary in regard to this matter.
(Signature)
DATE
I, an attorney in good standing and a member of the Bar of
have been retained and am representing
, a prisoner confined at
in the matter of
(Signature)
DATE
APPROVED:
(Commandant/Confinement Officer)
NOTE: Individual military counsel is a nonappropriated military counsel. Appointed military defense counsel, either trial or
appellate, will not be required to complete this form.
DA FORM 2569-R, SEP 2009
APD LC v1.00
PREVIOUS EDITIONS ARE OBSOLETE.
ATTORNEY OF RECORD DESIGNATION
(Civilian and Individual Military Counsel)
For use of this form, see AR 190-47; the proponent agency is DCS, G-1.
DATE
, Service No.
I,
Register Number
, have retained
an attorney whose address is
to represent me in the matter of
I request that said attorney be permitted to visit me and to communicate with me as necessary in regard to this matter.
(Signature)
DATE
I, an attorney in good standing and a member of the Bar of
have been retained and am representing
, a prisoner confined at
in the matter of
(Signature)
DATE
APPROVED:
(Commandant/Confinement Officer)
NOTE: Individual military counsel is a nonappropriated military counsel. Appointed military defense counsel, either trial or
appellate, will not be required to complete this form.
DA FORM 2569-R, SEP 2009
APD LC v1.00
PREVIOUS EDITIONS ARE OBSOLETE.

Download DA Form 2569-R Attorney of Record Designation (Civilian and Individual Military Counsel)

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