DSCA's E-SAMM - Figure C11.F10. Certificate of Delivery

Certificate of Delivery

Pursuant to the provisions of the Lease Agreement executed [insert date] between our respective Governments, the undersigned as the authorized representative of the

Government Of
	Purchaser

accepts the below described [insert defense articles] together with its on board equipment from

Authorized Representative

Authorized representative of the United States
	DoD Component


Item	Nomenclature	Quantity

BY		BY
		Government of
		Purchaser
Title		Title
Date		Date
U.S. Representative		Representative

Recommended distribution:

Original to:	MILDEP JAG
Copies to:	DSCA MILDEP SA Activity SCO DFAS Indianapolis

Page Updated 02-12-2013