Transcription of REVERSE OF PART 3. ADMIN. USE ONLY NOT …
1 29b. DATE (YYMMDD)10. TYPE LEAVESEE REVERSE FORPRIVACY ACTSTATEMENT21. RATION STATUS ( enlisted )20. leave ADDRESS 13. DAYS REQUESTED14. FROM (Hour, Date) (YYMMDD)6. SHIP/STATION17. leave BALANCE18. leave USED THIS FY7. DEPT/DIV8. DUTY SECTIONFOR USE OUTUS ONLY11a. Leaving Area of PERMDUTYSTA11b. Taking leave INCONUS9. DUTY PHONE12. MODE OF TRAVEL3. SSN4. NAME (Last, First, MI)5. PAYGRADE1. DATE OF CERTIFY THAT THE ABOVEIS CORRECT AND PROPER TOTHE BEST OF MY CERTIFYING OFFICER'S TYPED NAME/RANK/TITLE33.
2 CERTIFYING OFFICER'S SIGNATURE27a. HOUR27b. DATE (YYMMDD)REGULARSICKEMERGENCYSEPARATIONRE TIREMENTOTHERYESNOYESNOAIRBUSCARTRAIN15. TO (Hour, Date) (YYMMDD)16. NORMAL WORKING HOURSDAY OF DEPARTURE:DAY OF RETURN:FROM:FROM:TO:TO:I CERTIFY THAT I HAVE SUFFICIENT FUNDS TO COVER THE COST OF ROUND TRIP TRAVEL. I UNDERSTAND THAT SHOULD ANY PORTION OF THISLEAVE, IF APPROVED, RESULT IN MY TAKING MORE leave THAN I CAN EARN ON MY CURRENT UNEXTENDED ENLISTMENT OR CURRENT ACTIVE DUTYOBLIGATION, MY PAY WILL BE CHECKED FOR SUCH EXCESS SIGNATURE OF APPLICANTLEAVE REQUEST/AUTHORIZATIONNAVCOMPT FORM 3065 (3PT) (REV.)
3 2-83)INSTRUCTIONS FOR COMPLETING THIS FORM AREON THE REVERSE OF part admin . USE ONLYAPPROVAL OF THIS leave ISNOT VALID WITHOUT CONTROL CONTROL RATIONS (COMRATS)Meal Pass to EDF meals exceptduring periods of leaveIN CONSIDERATION OF THE MEMBER'S COMPLETION OF A FULL WORKDAY (AS DEFINED IN MILPERSMAN,NAVPERS 15560) ON THE DAYS OF DEPARTURE AND RETURN, THE INCLUSIVE DAYS SHOWN ARE CORRECTAND PROPER FOR CHARGING AS HOUR28b. DATE (YYMMDD)27c. OOD'S SIGNATURE28c. OOD'S SIGNATUREDEPARTED ON LEAVERETURNED FROM LEAVEGRANTED EXTENSION OF leave ENDING29a. HOURDAYS AS OF29c. AUTHORIZING OFFICER'S SIGNATURE30.
4 INCLUSIVELEAVE PERIODTO BECHARGEDFIRST:LAST:31. NO. OF DAYSS/N 0104-LF-703-0656(YY)(MM)(DD)(YY)(MM)(DD) DATEDATEDATEDATEDATERECOMMENDEDYESNOYESN OYESNOYESNO23. APPROVEDDISAPPROVEDREVIEWING OFFICER'S NAME AND SIGNATURE24. COMMENTS/REMARKS 25. SHIP OR STATION (Including telegraphic address)26. REPORT ON EXPIRATION OF leave TO (If other than block 25)19. leave PHONE( ) part 1 FORWARD THIS COPY TO PERSONNEL OFFICE VIA COMMAND only ON COMPLETION OF leave .
