Pay Adjustment Authorization (Dd Form 139) printable pdf download

Pay Adjustment Authorization (Dd Form 139)

NOTE: If member has been transferred, forward this authorization to the

PAY ADJUSTMENT AUTHORIZATION

officer currently maintaining the member’s pay record.

MEMBER (Last name)

(First)

(Middle)

SSAN

GRADE/RANK/RATE

BRANCH OF SERVICE

DATE

LAST PAY RECORD EXAMINED

PAY GRADE NO.

AMOUNT

APPROPRIATION DATA

(If applicable)

FROM

NAME OF ACCOUNTABLE D.O.

SYMBOL NO.

G.A.O. EXCEPTION CODE

YOU ARE HEREBY AUTHORIZED TO

CHARGE

CREDIT

THE MILITARY PAY RECORD OF THE

MEMBER LISTED ABOVE

EXPLANATION AND/OR REASON FOR ADJUSTMENT

The above adjustment is based on a thorough examination of all available records. If the Disbursing Officer has knowledge that a previous adjustment has been

made or why the adjustment should not be made for the same item, this authorization should be returned with a brief statement of the reason for failure to make

adjustment.

FROM

CERTIFYING OFFICER (Name, rank/grade, and signature)

I CERTIFY that the adjustment indicated above has been entered on the above-named member’s Military Pay Record. (If adjustment has not been entered,

give explanation on reverse over D.O.’s signature and symbol number.)

TYPED NAME AND GRADE OF D.O.

D.O. SYMBOL NO.

DATE

SIGNATURE

DD FORM 139, MAY 53 (EG)

Form approved by Comp. Gen., U.S.

EDITION OF THIS FORM NOT HAVING SSAN IS OBSOLETE AFTER 30 JUN 69.