DA FORM 4916 Fillable – Army Pubs 4916 PDF

DAFORMFILLABLE.COM | DA FORM 4916 Fillable – Army Pubs 4916 PDF – DA FORM 4916, also known as the Certificate of Service/Attempted Service, is a critical document used within the United States Army for recording and verifying the service or attempted service of legal documents. This form, with the Pub/Form Number DA FORM 4916, has been in active use since June 1, 2009.

DA FORM 4916 – Certificate Of Service/Attempted Service

Form Number DA Form 4916
Form Title Certificate Of Service/Attempted Service
Form Date 06/01/2009
Form Proponent TJAG

Purpose and Importance of DA FORM 4916

What is DA FORM 4916?

DA FORM 4916 is a formal record that certifies the service or attempted service of legal documents to an individual or entity. This form is essential in ensuring that the legal process is followed correctly and that there is a verifiable record of the service attempt.

Key Features of DA FORM 4916

The form includes several critical details:

  • Date of Service or Attempted Service: This indicates when the service was carried out or attempted.
  • Recipient Information: Details of the individual or entity to whom the documents were served or attempted to be served.
  • Server Information: Details of the person who served or attempted to serve the documents.
  • Method of Service: Specifies how the service was attempted, such as in person, by mail, or other means.

Pub/Form Proponent and Status

The Pub/Form Proponent for DA FORM 4916 is the TJAG (The Judge Advocate General’s Corps), ensuring the form’s legal validity and proper use. The form is currently in ACTIVE status, meaning it is approved for use and distribution.

Prescribed Forms and Directives

DA FORM 4916 is prescribed by AR 27-10, which outlines the procedures for military justice and legal administration. This directive ensures that the form is used correctly within the legal framework of the U.S. Army.

Distribution and Security

Distribution Restrictions

The form has a Distribution Restriction Code A, meaning it is approved for public release and distribution is unlimited. This ensures that the form is accessible to all personnel who need to use it.

Security Classification

DA FORM 4916 is classified as UNCLASSIFIED, meaning it does not contain sensitive information that requires restricted access.

Historical Context

Superseded Forms

DA FORM 4916 superseded the earlier version, DA FORM 4916-R, which was used from March 1, 1985. This update ensures the form meets current legal and administrative requirements.

Electronic Media

The form is produced only in electronic media, as indicated by the footnote 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA. This aligns with modern record-keeping practices, enhancing accessibility and ease of use.

Usage Scenarios

When to Use DA FORM 4916

This form is used in various scenarios within the Army, including:

  • Serving legal documents related to military justice.
  • Verifying that an individual or entity has been properly notified of legal actions or proceedings.
  • Documenting attempted service when actual service could not be completed.

How to Complete DA FORM 4916

To complete DA FORM 4916, the following steps are essential:

  1. Fill in the Service Date: Clearly indicate the date when the service was performed or attempted.
  2. Detail Recipient Information: Accurately provide the name and address of the recipient.
  3. Provide Server Information: Include the name and contact details of the person who served or attempted to serve the documents.
  4. Describe the Method of Service: Specify how the documents were served, ensuring all relevant details are included.


DA FORM 4916 – Certificate Of Service/Attempted Service is an essential document in the legal and administrative processes of the U.S. Army. By providing a verifiable record of service or attempted service, it ensures that legal procedures are followed correctly and transparently. Understanding the proper use and importance of this form is crucial for all personnel involved in legal and administrative duties within the Army.

For further information or access to the form, refer to the prescribed directive AR 27-10 or consult the TJAG office.

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