Transcription of REQUEST AND AUTHORITY FOR LEAVE 1. …
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REQUEST AND AUTHORITY FOR LEAVE 1. …
REQUEST AND AUTHORITY FOR LEAVEThis form is subject to the Privacy Act of 1974. For use of this form, see AR proponent agency is ODCSPER. (See instructions on reverse.)28. DATE ISSUED13. SIGNATURE AND TITLE OFAPPROVING AUTHORITY6. LEAVE ADDRESS (Street, City, State, ZIP Code and Phone No.) III - DEPENDENT TRAVEL OF 1 AUG 75 IS OBSOLETEPART I7. TYPE OF LEAVEORDINARY EMERGENCYPERMISSIVE TDY OTHERNUMBER DAYS SUPERVISOR RECOMMENDATION/SIGNATUREAPPROVAL IV - AUTHENTICATION FOR TRAVEL AUTHORIZATIONa. DEPENDENTS (Last name, First, MI) b. RELATIONSHIPc. DATES OF BIRTH (Children)d. PASSPORT NUMBER DEPENDENT LEAVE is from toPART II - EMERGENCY LEAVE TRANSPORTATION AND TRAVEL18. You are authorized to proceed on official travel in connection with emergency LEAVE and upon completion of your LEAVE and travel willreturn to home station (or location) designated by military orders.
PRIVACY ACT STATEMENT AUTHORITY: PRINCIPAL PURPOSE(S): ROUTINE USES: DISCLOSURE: Title 5, USC, Section 301. To authorize military leave, document start and stop of such leave; record address and telephone number
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