DD Form 619 Statement of Accessorial Services Performed

DD Form 619 or the "Statement Of Accessorial Services Performed" is a Department of Defense-issued form used by and within the United States Army.

The form - often mistakenly referred to as the DA form 619 - was last revised on May 1, 2008. Download an up-to-date fillable PDF version of the DD 619 down below or find it on the Department of Defense documentation website.

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CONTAINS INFORMATION SUBJECT TO THE PRIVACY ACT OF 1974, AS AMENDED.
STATEMENT OF ACCESSORIAL SERVICES PERFORMED
OMB No. 0702-0022
OMB approval expires
This form is required only when accessorial services are chargeable to the Government. Carrier will enter complete information or
May 31, 2011
"None" in columns. "Unit Price" and "Charge" columns may be omitted when charges are itemized on the Standard Form 1113.
The public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 1155 Defense
Pentagon, Washington, DC 20301-1155 (0702-0022). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with
a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.
1. GOVERNMENT BILL OF LADING NUMBER
2. DATE OF PICKUP AT ORIGIN
16. ACCESSORIAL SERVICES
(YYYYMMDD)
PACKING, PACK MATERIALS AND UNPACKING
NUMBER
UNIT PRICE
CHARGE
(1)
(2)
(3)
(4)
3.a. NAME OF OWNER (Last, First, Middle Initial)
a. DISH PACK
b. SSN
c. RANK OR GRADE
b. CARTONS (Less than 3 cubic feet)
c. CARTONS (3 cubic feet)
4. ORIGIN OF SHIPMENT
5. DESTINATION OF SHIPMENT
d. CARTONS (4-1/2cubic feet)
e. CARTONS (8 cubic feet)
6.a. ORDERING ACTIVITY/INSTALLATION
b. LOCATION
f. CARTONS (8-1/2 cubic feet)
NAME
g. WARDROBE (Not less than 10 cubic feet)
h. MATTRESS, CRIB
7.a. NAME OF CARRIER
b. NAME OF AGENT (Last, First, Middle Initial)
i. MATTRESS (Not exceeding 39" x 75")
j. MATTRESS (Not exceeding 54" x 75")
8. SIGNATURE OF CARRIER'S REPRESENTATIVE
9. DATE
k. MATTRESS (39" x 80")
(YYYYMMDD)
l. MATTRESS (Exceeding 54" x 75")
m. TOTAL
10. CARRIER'S SHIPMENT REFERENCE NO.
11. AGENT OR DRIVER CODE
n. TOTAL SUBJECT MAX-PAK $
/cwt)
o. GRANDFATHER CLOCK CARTONS
LBS.
p. CORRUGATED CONTAINERS (Special constr.)
12. PROFESSIONAL BOOKS, PAPERS AND EQUIPMENT (PBP&E)
INCLUDED IN SHIPMENT (If not included, write "None".)
q. BOXES - WOODEN/CRATES (Not over 5 cu.ft.)
r. BOXES (Over 5 cu.ft./not over 8 cu.ft.)
13. STORAGE-IN-TRANSIT (SIT)
b. SIT SERVICES PROVIDED AT (X one)
s. BOXES (Over 8 cu.ft.) (Gross cu.ft.:
a. STORED AT (1) CITY
(2) STATE
)
)
ORIGIN
DESTINATION
OTHER
t. CRATES (Cubic feet:
f. NUMBER
g. NET WEIGHT
(Minimum charge:
)
DATES (YYYYMMDD):
OF DAYS
c. IN
d. ORDERED OUT e. DELIVERED OUT
u. CARTONS, DOUBLE WALL (PPP-B-1364) &
TRIPLE WALL (PPP-B-640) (Not over 4 cu.ft.)
h. REQUESTED DELIVERY
i. SHIPMENT ORDERED INTO AND OUT OF SIT ON DATES
v. CARTONS (Over 4 cu.ft./less than 7 cu.ft.)
DATE (YYYYMMDD)
INDICATED AND AUTHORIZED BY SIT CONTROL NO.
w. CARTONS (7 cu.ft./less than 15 cu.ft.)
j. WAS STORAGE POINT FOR CARRIER'S CONVENIENCE (X one)
x. TOTAL PACKING CHARGE
YES
NO
a. NUMBER
14. REWEIGH CERTIFICATION (If applicable)
y. LABOR (Describe service in "Remarks")
(Enter number of man-hours)
b. ORIGINAL GROSS
c. REWEIGH GROSS
EXTRA DELIVERY
d. ORIGINAL TARE
e. REWEIGH TARE
z. (X as applicable)
f. ORIGINAL NET
g. REWEIGH NET
EXTRA PICKUP
AUXILIARY SERVICES
15. APPLIANCES SERVICED (Owner/Agent must initial each entry separately.)
aa. PIANO/ORGAN CARRY SERVICE
OWNER/AGENT
TYPE
MAKE/MODEL NO./MANUFACTURER
bb. ELEVATOR/STAIR/EXCESS DISTANCE
INITIALS
a.
b.
c.
cc. SERVICING APPLIANCES/OTHER ARTICLES
(As itemized and initialed in Item 15)
dd. OTHER (Describe in "Remarks")
ee. TOTAL ACCESSORIAL SERVICE CHARGES
17. REMARKS
18. STATEMENT OF OWNER, MILITARY INSPECTOR/TRANSPORTATION OFFICER
b. SIGNATURE (Do not sign until Carrier has completed column 16(2).)
c. DATE SIGNED
a. MATERIALS WERE FURNISHED/ACCESSORIAL SERVICES WERE PERFORMED
(YYYYMMDD)
AT ORIGIN
OTHER (Explain)
AT DESTINATION
19. TRANSPORTATION OFFICER CERTIFICATION. I CERTIFY THAT SHIPMENT SERVICES WERE ACCOMPLISHED AS SHOWN BELOW.
a. SERVICES ACCOMPLISHED (X as applicable)
(3) REWEIGH CERTIFICATION
(6) WAITING TIME
(9) OTHER (Specify)
(1) ACCESSORIAL SERVICES (Listed in Item 16)
(7) UNPACKING SERVICE (Baggage only)
(4) THIRD PARTY SERVICES
(5) BULKY ARTICLE CHARGE
(2) STORAGE-IN-TRANSIT
(8) OVERTIME LOADING/UNLOADING CHARGE
d. DATE SIGNED
b. SIGNATURE OF TRANSPORTATION OFFICER
c. TITLE (Print or type)
(YYYYMMDD)
DD FORM 619, MAY 2008
Reset
PREVIOUS EDITION MAY BE USED.
Adobe Professional 7.0
CONTAINS INFORMATION SUBJECT TO THE PRIVACY ACT OF 1974, AS AMENDED.
STATEMENT OF ACCESSORIAL SERVICES PERFORMED
OMB No. 0702-0022
OMB approval expires
This form is required only when accessorial services are chargeable to the Government. Carrier will enter complete information or
May 31, 2011
"None" in columns. "Unit Price" and "Charge" columns may be omitted when charges are itemized on the Standard Form 1113.
The public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 1155 Defense
Pentagon, Washington, DC 20301-1155 (0702-0022). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with
a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.
1. GOVERNMENT BILL OF LADING NUMBER
2. DATE OF PICKUP AT ORIGIN
16. ACCESSORIAL SERVICES
(YYYYMMDD)
PACKING, PACK MATERIALS AND UNPACKING
NUMBER
UNIT PRICE
CHARGE
(1)
(2)
(3)
(4)
3.a. NAME OF OWNER (Last, First, Middle Initial)
a. DISH PACK
b. SSN
c. RANK OR GRADE
b. CARTONS (Less than 3 cubic feet)
c. CARTONS (3 cubic feet)
4. ORIGIN OF SHIPMENT
5. DESTINATION OF SHIPMENT
d. CARTONS (4-1/2cubic feet)
e. CARTONS (8 cubic feet)
6.a. ORDERING ACTIVITY/INSTALLATION
b. LOCATION
f. CARTONS (8-1/2 cubic feet)
NAME
g. WARDROBE (Not less than 10 cubic feet)
h. MATTRESS, CRIB
7.a. NAME OF CARRIER
b. NAME OF AGENT (Last, First, Middle Initial)
i. MATTRESS (Not exceeding 39" x 75")
j. MATTRESS (Not exceeding 54" x 75")
8. SIGNATURE OF CARRIER'S REPRESENTATIVE
9. DATE
k. MATTRESS (39" x 80")
(YYYYMMDD)
l. MATTRESS (Exceeding 54" x 75")
m. TOTAL
10. CARRIER'S SHIPMENT REFERENCE NO.
11. AGENT OR DRIVER CODE
n. TOTAL SUBJECT MAX-PAK $
/cwt)
o. GRANDFATHER CLOCK CARTONS
LBS.
p. CORRUGATED CONTAINERS (Special constr.)
12. PROFESSIONAL BOOKS, PAPERS AND EQUIPMENT (PBP&E)
INCLUDED IN SHIPMENT (If not included, write "None".)
q. BOXES - WOODEN/CRATES (Not over 5 cu.ft.)
r. BOXES (Over 5 cu.ft./not over 8 cu.ft.)
13. STORAGE-IN-TRANSIT (SIT)
b. SIT SERVICES PROVIDED AT (X one)
s. BOXES (Over 8 cu.ft.) (Gross cu.ft.:
a. STORED AT (1) CITY
(2) STATE
)
)
ORIGIN
DESTINATION
OTHER
t. CRATES (Cubic feet:
f. NUMBER
g. NET WEIGHT
(Minimum charge:
)
DATES (YYYYMMDD):
OF DAYS
c. IN
d. ORDERED OUT e. DELIVERED OUT
u. CARTONS, DOUBLE WALL (PPP-B-1364) &
TRIPLE WALL (PPP-B-640) (Not over 4 cu.ft.)
h. REQUESTED DELIVERY
i. SHIPMENT ORDERED INTO AND OUT OF SIT ON DATES
v. CARTONS (Over 4 cu.ft./less than 7 cu.ft.)
DATE (YYYYMMDD)
INDICATED AND AUTHORIZED BY SIT CONTROL NO.
w. CARTONS (7 cu.ft./less than 15 cu.ft.)
j. WAS STORAGE POINT FOR CARRIER'S CONVENIENCE (X one)
x. TOTAL PACKING CHARGE
YES
NO
a. NUMBER
14. REWEIGH CERTIFICATION (If applicable)
y. LABOR (Describe service in "Remarks")
(Enter number of man-hours)
b. ORIGINAL GROSS
c. REWEIGH GROSS
EXTRA DELIVERY
d. ORIGINAL TARE
e. REWEIGH TARE
z. (X as applicable)
f. ORIGINAL NET
g. REWEIGH NET
EXTRA PICKUP
AUXILIARY SERVICES
15. APPLIANCES SERVICED (Owner/Agent must initial each entry separately.)
aa. PIANO/ORGAN CARRY SERVICE
OWNER/AGENT
TYPE
MAKE/MODEL NO./MANUFACTURER
bb. ELEVATOR/STAIR/EXCESS DISTANCE
INITIALS
a.
b.
c.
cc. SERVICING APPLIANCES/OTHER ARTICLES
(As itemized and initialed in Item 15)
dd. OTHER (Describe in "Remarks")
ee. TOTAL ACCESSORIAL SERVICE CHARGES
17. REMARKS
18. STATEMENT OF OWNER, MILITARY INSPECTOR/TRANSPORTATION OFFICER
b. SIGNATURE (Do not sign until Carrier has completed column 16(2).)
c. DATE SIGNED
a. MATERIALS WERE FURNISHED/ACCESSORIAL SERVICES WERE PERFORMED
(YYYYMMDD)
AT ORIGIN
OTHER (Explain)
AT DESTINATION
19. TRANSPORTATION OFFICER CERTIFICATION. I CERTIFY THAT SHIPMENT SERVICES WERE ACCOMPLISHED AS SHOWN BELOW.
a. SERVICES ACCOMPLISHED (X as applicable)
(3) REWEIGH CERTIFICATION
(6) WAITING TIME
(9) OTHER (Specify)
(1) ACCESSORIAL SERVICES (Listed in Item 16)
(7) UNPACKING SERVICE (Baggage only)
(4) THIRD PARTY SERVICES
(5) BULKY ARTICLE CHARGE
(2) STORAGE-IN-TRANSIT
(8) OVERTIME LOADING/UNLOADING CHARGE
d. DATE SIGNED
b. SIGNATURE OF TRANSPORTATION OFFICER
c. TITLE (Print or type)
(YYYYMMDD)
DD FORM 619, MAY 2008
Reset
PREVIOUS EDITION MAY BE USED.
Adobe Professional 7.0

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