DA Form R-3 Ceremonial Rifle Inventory Form

DA Form R-3 - also known as the "Ceremonial Rifle Inventory Form" - 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 R-3 - was last revised on March 1, 2015. Download an up-to-date PDF version of the DA R-3 below or request a copy through the chain of command.

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CEREMONIAL RIFLE INVENTORY FORM
SECTION I – ORGANIZATION INFORMATION
1. Organization Name:
2. City:
3. State:
SECTION II – STATUS OF US ARMY OWNED CEREMONIAL RIFLES ISSUED TO ORGANIZATION
In accordance with the Conditional Deed of Gift(s), AR 700-131 and Title 10 USC §4683, I hereby
certify that the following United States Army owned rifles conditionally issued for ceremonial use to
the above organization are:
still required and used in the manner agreed upon in the original statement.
require replacement (place an asterisk (*) next to every rifle that requires replacement).
no longer required. Request the ceremonial rifle team provide disposition instructions to return
ceremonial rifles.
Our organization does not have any ceremonial rifles on hand.
SECTION III – RIFLE LISTING
Model:
Manufacturer:
Serial Number:
1.
Model:
Manufacturer:
Serial Number:
2.
Model:
Manufacturer:
:
Serial Number
3.
Model:
Manufacturer:
Serial Number:
4.
Model:
Manufacturer:
Serial Number:
5.
Model:
Manufacturer:
Serial Number:
6.
Model:
Manufacturer:
Serial Number:
7.
Model:
Manufacturer:
Serial Number:
8.
Model:
Manufacturer:
Serial Number:
9.
Model:
Manufacturer:
Serial Number:
10.
Model:
Manufacturer:
Serial Number:
11.
Model:
Manufacturer:
Serial Number:
12.
ADPO R-3, March 2015
Page 1 of 2
CEREMONIAL RIFLE INVENTORY FORM
SECTION I – ORGANIZATION INFORMATION
1. Organization Name:
2. City:
3. State:
SECTION II – STATUS OF US ARMY OWNED CEREMONIAL RIFLES ISSUED TO ORGANIZATION
In accordance with the Conditional Deed of Gift(s), AR 700-131 and Title 10 USC §4683, I hereby
certify that the following United States Army owned rifles conditionally issued for ceremonial use to
the above organization are:
still required and used in the manner agreed upon in the original statement.
require replacement (place an asterisk (*) next to every rifle that requires replacement).
no longer required. Request the ceremonial rifle team provide disposition instructions to return
ceremonial rifles.
Our organization does not have any ceremonial rifles on hand.
SECTION III – RIFLE LISTING
Model:
Manufacturer:
Serial Number:
1.
Model:
Manufacturer:
Serial Number:
2.
Model:
Manufacturer:
:
Serial Number
3.
Model:
Manufacturer:
Serial Number:
4.
Model:
Manufacturer:
Serial Number:
5.
Model:
Manufacturer:
Serial Number:
6.
Model:
Manufacturer:
Serial Number:
7.
Model:
Manufacturer:
Serial Number:
8.
Model:
Manufacturer:
Serial Number:
9.
Model:
Manufacturer:
Serial Number:
10.
Model:
Manufacturer:
Serial Number:
11.
Model:
Manufacturer:
Serial Number:
12.
ADPO R-3, March 2015
Page 1 of 2
CEREMONIAL RIFLE INVENTORY FORM
SECTION III – RIFLE LISTING (CONTINUED)
Model:
Manufacturer:
Serial Number:
13.
Model:
Manufacturer:
Serial Number:
14.
Model:
Manufacturer:
Serial Number:
15.
Model:
Manufacturer:
Serial Number:
16.
Model:
Manufacturer:
Serial Number:
17.
Model:
Manufacturer:
Serial Number:
18.
Model:
Manufacturer:
Serial Number:
19.
Model:
Manufacturer:
Serial Number:
20.
If you have additional weapons, list them on a separate piece of paper and attach
to this form.
SECTION IV – ACKNOWLEDGEMENT
By signing below, I hereby certify that to the best of my knowledge and belief that a 100% inventory of all Ceremonial
Rifles in our possession was performed and that the rifles listed above (and on attachments) are the only rifles in the
possession of this organization at this time and that all of my statements are true, correct, complete and made in good
faith. I understand and acknowledge that concealing material fact and/or making a false statement is a violation of Title
18 USC §1001 and may result in the cancellation of the Conditional Deed for any US Army property on loan to my
organization and is punishable by fine or imprisonment. Furthermore, if any additional rifles are located we will notify the
US Army within 30 days of their discovery.
1. Signature of Highest Ranking Official:
2. Date Signed:
3. Printed Name of Person Signing (First, Middle Initial, Last):
4. Title of Signer:
5. Organization Telephone Number:
6. Organization Email Address:
SECTION V – NOTARY ENDORSEMENT
1. Official Notary Signature:
2. Notary Seal/Stamp:
DUE:
Mail to: US ARMY TACOM LCMC, ATTN: AMSTA-LCL-IWD, M/S 419D, 6501 East 11 Mile Road, Warren, MI 48397-5000
ADPO R-3, March 2015
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