In the United States ____________1 Court of Criminal Appeals

(Full typed name, rank, service, & service number of accused)

Direction for Review Case No. ________

Tried at (location), on (date(s)) before a (type in court-martial) appointed by (convening authority)

To the Honorable, the Judges of the United States ____________ Court of Criminal Appeals

1. Pursuant to Article 69 of the Uniform Code of Military Justice, 10 U.S.C. §869 (1994) and the Rules of Practice and Procedure for Courts of Criminal Appeals, Rule 2(b), the record of trial in the above-entitled case is forwarded for review.

2. The accused was found guilty by a (type of court-martial) of a violation of Article(s) ________ of the Uniform Code of Military Justice, and was sentenced to (include entire adjudged sentence) on (insert trial date). The convening authority (approved the sentence as adjudged) (approved the following findings and sentence: ____________). The officer exercising general court-martial jurisdiction (where applicable) took the following action: ____________. The case was received for review pursuant to Article 69 on (date).

3. In review, pursuant to Uniform Code of Military Justice, Article 66, it is requested that action be taken with respect to the following issues:

[set out issues here]

The Judge Advocate General

Received a copy of the foregoing Direction for Review this ____________ (date).

Appellate Government Counsel

Address and telephone number

Appellate Defense Counsel

Address and telephone number