DD Form 3076-5 "Military Working Dog (Mwd) Covenant Not to Sue With Indemnity Agreement (Adoption)"

What Is DD Form 3076-5?

This is a form that was released by the U.S. Department of Defense (DoD) on October 1, 2019. The form, often mistakenly referred to as the DA Form 3076-5, 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 DoD.

Form Details:

  • A 2-page document available for download in PDF;
  • The latest version available from the Executive Services Directorate;
  • Editable, printable, and free to use;

Download an up-to-date fillable DD Form 3076-5 down below in PDF format or browse hundreds of other DoD Forms compiled in our online library.

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Download DD Form 3076-5 "Military Working Dog (Mwd) Covenant Not to Sue With Indemnity Agreement (Adoption)"

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FOR OFFICIAL USE ONLY UPON COMPLETION
COVENANT NOT TO SUE WITH INDEMNITY AGREEMENT (ADOPTION)
I,
(insert name of adoptee), voluntarily accept from the US Government the delivery by means of transfer the following
described military working dog, hereafter referred to as "MWD."
MWD NAME:
TATTOO NUMBER:
WELP DATE:
GENDER:
BREED
INSTALLATION
ELIMATED FROM:
I understand and agree that this transfer of the MWD is pursuant to 10 U.S.C., Section 2583, which applies to transfer and adoption to military working
dogs. Section 2583 (e) (1) provides that "Not withstanding any other provision of law, the United States shall not be subject to any suit, claim, demand or action,
liability, judgment, cost or other fee arising out of any claim for personal injury or property damage (including death, illness, or loss of or damage to property of
other economic loss) that results from, or is in any manner predicated upon, the act of omission of a former military animal transferred under this section, including
any training provided to the animal while a military animal."
I acknowledge that the above mentioned MWD HAS or HAS NOT received DoD controlled aggression (patrol) training and having such knowledge, and
as a condition of being the recipient or adoptee of the MWD, I freely and voluntarily accept all risks and consequences of the future conduct and acts of the dog.
In consideration of the transfer, I agree that the MWD will not be used for illegal purpose, police, or security related activity, private business activity, substance
detection either public or private, nor will the MWD be given or sold to another person.
In consideration of this transfer, I, for myself, my heirs, administrators, executors, and assigns, hereby covenant and agree that I will never institute,
prosecute, or in any way aid in the institution or prosecution of , any demand, claim, or suit against the US Government for any damage, loss, or injury (including
death) to my person or property which may be caused directly or indirectly by the above described MWD, however and whenever the same may be caused. If I,
my heirs, administrators, executors, or assigns should demand, claim, sue, or aid in any way in such a demand, claim, or suit, I agree, for myself, my heirs,
administrators, executors, or assigns to indemnify the US Government for all damages, expenses, and costs it may incur as a result thereof. In consideration of
this transfer, I further agree to indemnify, defend, and hold harmless the US Government, to the fullest extent permitted by applicable law, from and against any
and all claims, demands, actions, suits, losses, costs, charges, expenses, damages, and liabilities whatsoever which the US Government may pay, sustain,
suffer, or incur that are attributed directly or indirectly to future conduct and acts of the above described MWD, including, but not limited to, those arising from prior
training given to the MWD by the US Government and the decision of the US Government to transfer the MWD. I also agree that the US Government, pursuant to
10 U.S.C., Section 2583, shall not be held liable for any veterinary expense or treatment of any kind associated with the transfer of the MWD as stated herein for
any condition of the MWD before transfer under this agreement, whether or not such condition is known at time of transfer under this agreement.
DD FORM 3076-5, OCT 2019
Page 0 of 1
PREVIOUS EDITION IS OBSOLETE.
FOR OFFICIAL USE ONLY UPON COMPLETION
FOR OFFICIAL USE ONLY UPON COMPLETION
COVENANT NOT TO SUE WITH INDEMNITY AGREEMENT (ADOPTION)
I,
(insert name of adoptee), voluntarily accept from the US Government the delivery by means of transfer the following
described military working dog, hereafter referred to as "MWD."
MWD NAME:
TATTOO NUMBER:
WELP DATE:
GENDER:
BREED
INSTALLATION
ELIMATED FROM:
I understand and agree that this transfer of the MWD is pursuant to 10 U.S.C., Section 2583, which applies to transfer and adoption to military working
dogs. Section 2583 (e) (1) provides that "Not withstanding any other provision of law, the United States shall not be subject to any suit, claim, demand or action,
liability, judgment, cost or other fee arising out of any claim for personal injury or property damage (including death, illness, or loss of or damage to property of
other economic loss) that results from, or is in any manner predicated upon, the act of omission of a former military animal transferred under this section, including
any training provided to the animal while a military animal."
I acknowledge that the above mentioned MWD HAS or HAS NOT received DoD controlled aggression (patrol) training and having such knowledge, and
as a condition of being the recipient or adoptee of the MWD, I freely and voluntarily accept all risks and consequences of the future conduct and acts of the dog.
In consideration of the transfer, I agree that the MWD will not be used for illegal purpose, police, or security related activity, private business activity, substance
detection either public or private, nor will the MWD be given or sold to another person.
In consideration of this transfer, I, for myself, my heirs, administrators, executors, and assigns, hereby covenant and agree that I will never institute,
prosecute, or in any way aid in the institution or prosecution of , any demand, claim, or suit against the US Government for any damage, loss, or injury (including
death) to my person or property which may be caused directly or indirectly by the above described MWD, however and whenever the same may be caused. If I,
my heirs, administrators, executors, or assigns should demand, claim, sue, or aid in any way in such a demand, claim, or suit, I agree, for myself, my heirs,
administrators, executors, or assigns to indemnify the US Government for all damages, expenses, and costs it may incur as a result thereof. In consideration of
this transfer, I further agree to indemnify, defend, and hold harmless the US Government, to the fullest extent permitted by applicable law, from and against any
and all claims, demands, actions, suits, losses, costs, charges, expenses, damages, and liabilities whatsoever which the US Government may pay, sustain,
suffer, or incur that are attributed directly or indirectly to future conduct and acts of the above described MWD, including, but not limited to, those arising from prior
training given to the MWD by the US Government and the decision of the US Government to transfer the MWD. I also agree that the US Government, pursuant to
10 U.S.C., Section 2583, shall not be held liable for any veterinary expense or treatment of any kind associated with the transfer of the MWD as stated herein for
any condition of the MWD before transfer under this agreement, whether or not such condition is known at time of transfer under this agreement.
DD FORM 3076-5, OCT 2019
Page 0 of 1
PREVIOUS EDITION IS OBSOLETE.
FOR OFFICIAL USE ONLY UPON COMPLETION
FOR OFFICIAL USE ONLY UPON COMPLETION
COVENANT NOT TO SUE WITH INDEMNITY AGREEMENT (ADOPTION) (continued)
Signature of Adopting Individual
Signature of DoD Representative
Adopter's Name (Printed)
DoD Representative's Name (Printed)
Address of Adopting Individual
Date
Phone Number/Email Address of Adopting Individual
STATE OF:
COUNTY OF:
Before me,
, a Notary Public, personally appeared the above listed Adopter known to me to be the person
whose name is subscribed to the foregoing instrument, and acknowledged to me that he/she executed the same for the purposes and considerations therein
expressed on this
day of
, 20
.
NOTARY PUBLIC
COMMISSION EXPIRATION
DD FORM 3076-5, OCT 2019
Page 1 of 1
PREVIOUS EDITION IS OBSOLETE.
FOR OFFICIAL USE ONLY UPON COMPLETION
Page of 2