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

What Is DA Form 2569-R?

This is a military form that was released by the U.S. Department of the Army (DA) on September 1, 2009. The form, often mistakenly referred to as the DD Form 2569-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 2569-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 2569-R "Attorney of Record Designation (Civilian and Individual Military Counsel)"

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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.