LEAVE REQUEST/AUTHORIZATION INSTRUCTIONS FOR …
instructions for completing this form are on the reverse of part 3 see reverse for privacy act statement 1. date of request 2. for admin use only approval of this leave is not valid without control leave control no. 3. ssn 4. name (last, first, mi) 5. pay grade 6. ship/station 7. dept/div 8. duty section 9. duty phone 1 10.
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