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TYPED NAME AND TITLE OF AUTHORIZED 12b. DATE SECTION C - Action by final approval authority APPROVED AUTHORITY DA FORM 4881-6-R SEP 84 DENIED OTHER SEE REVERSE USAPPC V1. M TAB REQUEST AND APPROVAL FOR LOAN OR LEASE OF EQUIPMENT AND LOAN OR LEASE AGREEMENT For use of this form see AR 700-131 the proponent agency is DCSLOG* LOAN OR LEASE Check one LOAN PAGE NO. NO. OF PAGES REQUIRED DELIVERY DATE LOAN/LEASE AGREEMENT NUMBER When Approved LEASE ADDRESS OF ACCOUNTABLE OFFICER EXPIRATION DATE OF LOAN/LEASE SECTION A - To be completed by Requester/Lessee 1. NAME AND ADDRESS OF ACTIVITY Include UIC 2. ITEM DESCRIPTION Include LIN and NSN and Quantity Required 3. OTHER ITEMS REQUIRED Show item page no. of request and agency to which request was submitted* A separate request is required for each item* 4. EQUIPMENT TO BE SHIPPED TO include DODAAC if applicable 5. FUND CITE FOR PC H AND TRANSPORTATION COSTS 6. COMPLETE JUSTIFICATION INCLUDING PROPOSED DURATION OF LOAN/LEASE If additional space is needed use reverse 7. CERTIFICATION I certify that I am the authorized individual to request loan/lease of Army equipment and if this request is approved agree to pay all authorized charges including PC H transportation and repair costs for other than fair wear and tear and agree to abide by all conditions specified for Loan/Lease of Army materiel by AR 700-131. 8. TYPED NAME GRADE AND TITLE OF AUTHORIZED REPRESENTATIVE 8a* SIGNATURE 8b. DATE 10. REQUESTED ITEM Enter NSN 10a* AVAILABILITY Check one SUBSTITUTE ITEM WITH DAMPL IMPACT WITHOUT DAMPL IMPACT NOT AVAILABLE 10b. APPROVAL AUTHORITY FOR LOAN/LEASE Based upon above data and Table 2-1 AR 700-131 11. FOR LOANS/LEASES WITH DAMPL IMPACT Provide the following information to HQDA 11a* AUTHORIZED ON HAND Worldwide QTY D/I PER MONTH PRODUCED 11b. QTY O/H CONUS DEPOT BY PURPOSE CODE OVERHAULED 11c* QTY BACKORDERED BY MACOM 11d. IMPACT OF LOAN/LEASE APPROVAL AND ACTIVITY RECOMMENDATION 12. M TAB REQUEST AND APPROVAL FOR LOAN OR LEASE OF EQUIPMENT AND LOAN OR LEASE AGREEMENT For use of this form see AR 700-131 the proponent agency is DCSLOG* LOAN OR LEASE Check one LOAN PAGE NO. NO. OF PAGES REQUIRED DELIVERY DATE LOAN/LEASE AGREEMENT NUMBER When Approved LEASE ADDRESS OF ACCOUNTABLE OFFICER EXPIRATION DATE OF LOAN/LEASE SECTION A - To be completed by Requester/Lessee 1. NO. OF PAGES REQUIRED DELIVERY DATE LOAN/LEASE AGREEMENT NUMBER When Approved LEASE ADDRESS OF ACCOUNTABLE OFFICER EXPIRATION DATE OF LOAN/LEASE SECTION A - To be completed by Requester/Lessee 1. NAME AND ADDRESS OF ACTIVITY Include UIC 2. ITEM DESCRIPTION Include LIN and NSN and Quantity Required 3. NAME AND ADDRESS OF ACTIVITY Include UIC 2. ITEM DESCRIPTION Include LIN and NSN and Quantity Required 3. OTHER ITEMS REQUIRED Show item page no. of request and agency to which request was submitted* A separate request is required for each item* 4. OTHER ITEMS REQUIRED Show item page no. of request and agency to which request was submitted* A separate request is required for each item* 4. EQUIPMENT TO BE SHIPPED TO include DODAAC if applicable 5. FUND CITE FOR PC H AND TRANSPORTATION COSTS 6.
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