Page 2 of C G-3853 ( Rev. 6-04)
SECTION III - STATEMENT OF CREDITORS
ATTACH LETT ERS, STATEMENTS OF CREDITORS (Describe each attachment below)
SIGNATURE (Commanding Officer or OIC) DATE
REMARKS
DISTRIBUTION
1. Original and two copies to officer designated by the Commanding Officer to assume custody of the effects.
a. Officer retains original.
b. Copy to be packed with personal effects.
c. Copy to next of kin (if personal effects are shipped to next of kin. Otherwise, copy goes to Supply Center, Baltimore).
2. Copy to Service Record.
3. Copy to Commandant (G-PMP) (if deceased, captured, missing, or incapacitated) or
Copy to Commandant (MPC) (if absent at time of sailing, AWOL, AOL, or deserter).
4. Copy to file of unit preparing inventory.
ORIGINAL - OFFICER DESIG TO ASSUME EFFECTS
1. Bank statement, Bank of America, 15 June 2012, account 987-6666-5543, balance
$1,713.88.
2. Bank statement, Navy Federal Credit Union, 18 June 2012, account 456-4444-3445,
balance $50.00.
3. Car loan, Navy Federal Credit Union, 12 June 2012, loan 008-7700-6543, balance
$12,331.01.
Ref: (a) COMDTINST M1770.9, Military Casualties & Decedent Affairs, 29 Sep 2011
(replaced PERSMAN Chapter 11)
Auction of perishable items is normal procedure. See reference (a), 1.K.2.b.
Converting perishables to cash protects their value for transfer to Next-Of-Kin.
Distribution notes: (MAIL HARDCOPY, FAX, OR SCAN & EMAIL (preferred for PSC))
Copy to PDR at SPO
Copy to Decedent Affairs Officer (DAO), usually at Base or TRACEN
Copy to USCG PSC (PSD-mr), Military Records
Copy to USCG PSC (PSD FS-Casualty), Program Manager for Casualty Matters
NOTE ADDRESS: Commander (PSD-mr) or (PSD FS-Casualty), USCG Personnel Service Center,
4200 Wilson Blvd., Suite 1100, STOP 7200, Arlington VA 20598-7200.
In most cases, the Person Authorized to Receive Effects (PERE) is the same as the
Person Authorized to Direct Disposition of remains (PADD). See member's CG-2020D.
If the quantity of effects is very small, they may be hand-delivered to PERE.
Usually there will be more than a seabag-full so in most cases it's best to ship to
PERE using the Household Goods (HHG) Bluebark TONO.
Normal procedure is for clothing to be laundered or dry cleaned, as needed. This is
an authorized Government expense. See reference (a), 1.K.2.d. (Casualty Matters may
reimburse unit. Coordinate reimbursement through DAO.)
Electronic data storage devices in Gov't possession should be reviewed for
potentially embarrassing content and for FOUO or classified content prior to shipment
to PADD. Delete inappropriate or unauthorized files.
Multiple inventories possible, e.g. Locker afloat, barracks room, gym locker, POV.