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NAVCOMPT FORM 3065 3PT REV. 2-83 2. FOR ADMIN USE ONLY APPROVAL OF THIS LEAVE IS NOT VALID WITHOUT CONTROL 4. NAME Last First MI 1. DATE OF REQUEST 3. SSN SEE REVERSE FOR PRIVACY ACT STATEMENT INSTRUCTIONS FOR COMPLETING THIS FORM ARE ON THE REVERSE OF PART 3 LEAVE REQUEST/AUTHORIZATION 6. SHIP/STATION LEAVE CONTROL NO. 5. PAY GRADE 7. DEPT/DIV 8. DUTY SECTION 9. DUTY PHONE FOR USE OUTUS ONLY 10. TYPE OF LEAVE REGULAR EMERGENCY SICK SEPARATION RETIREMENT 11a* Leaving Area of P E R M D U T Y S T A AIR BUS OTHER* YES NO 11b. Taking Leave I N C O N U S CAR TRAIN 13. DAYS REQUESTED 14. FROM Hour Date YYMMDD 17. LEAVE BALANCE* 18. LEAVE USED THIS FY DAYS AS OF* 12. MODE OF TRAVEL 15. TO Hour Date YYMMDD 16. NORMAL WORKING HOURS DAY OF DEPARTURE TO FROM 19. LEAVE PHONE DAY OF RETURN 20. LEAVE ADDRESS 21. RATION STAUS Enlisted I C E R T I F Y T H A T I H A V E S U F F I C IE N T F U N D S T O C O V E R T H E C O S T O F R O U N D T R IP T R A V E L. I U N D E R S T A N D T H A T S H O U L D A N Y P O R T I O N O F T H I S L E A V E I F A P P R O V E D R E S U L T S IN M Y T A K I N G M O R E L E A V E T H A N I C A N E A R N O N M Y C U R R E N T U N E X T E N D E D E N L IS T M E N T O R C U R R E N T A C T IV E D U T Y O B L IG A T IO N M Y P A Y W IL L B E C H E C K E D F O R S U C H E X C E S S L E A V E RECOMMENDED COMMUTED RATIONS COMRATS MEAL PASS NO. Entitled to EDF meals except during periods of leave SIGNATURE OF APPLICANT DATE 23. APPROVED DISAPPROVED REVIEWING OFFICER S NAME AND SIGNATURE 24. COMMENTS/REMARKS 25. SHIP OR STATION Including telegraphic address 27a* HOUR DEPARTED ON LEAVE 27b. DATE YYMMDD 27c* OOD S SIGNATURE 26. REPORT ON EXPIRATION OF LEAVE TO If other than block 25 RETURNED FROM LEAVE IN 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 CORRECT AND PROPER FOR CHARGING AS LEAVE* CORRECT AND PROPER TO THE BEST OF MY KNOWLEDGE 30. INCLUSIVE LEAVE PERIOD TO BE CHARGED CERTIFYING OFFICER S TYPE NAME/RANK/TITLE WHITE COPY GRANTED EXTENSION OF LEAVE ENDING FIRST YY MM DD LAST 31. NAME Last First MI 1. DATE OF REQUEST 3. SSN SEE REVERSE FOR PRIVACY ACT STATEMENT INSTRUCTIONS FOR COMPLETING THIS FORM ARE ON THE REVERSE OF PART 3 LEAVE REQUEST/AUTHORIZATION 6. SHIP/STATION LEAVE CONTROL NO. 5. PAY GRADE 7. DEPT/DIV 8. DUTY SECTION 9. DUTY PHONE FOR USE OUTUS ONLY 10. SHIP/STATION LEAVE CONTROL NO. 5. PAY GRADE 7. DEPT/DIV 8. DUTY SECTION 9. DUTY PHONE FOR USE OUTUS ONLY 10. TYPE OF LEAVE REGULAR EMERGENCY SICK SEPARATION RETIREMENT 11a* Leaving Area of P E R M D U T Y S T A AIR BUS OTHER* YES NO 11b. TYPE OF LEAVE REGULAR EMERGENCY SICK SEPARATION RETIREMENT 11a* Leaving Area of P E R M D U T Y S T A AIR BUS OTHER* YES NO 11b. Taking Leave I N C O N U S CAR TRAIN 13. DAYS REQUESTED 14. FROM Hour Date YYMMDD 17. LEAVE BALANCE* 18. Taking Leave I N C O N U S CAR TRAIN 13. DAYS REQUESTED 14. FROM Hour Date YYMMDD 17. LEAVE BALANCE* 18. LEAVE USED THIS FY DAYS AS OF* 12. MODE OF TRAVEL 15. TO Hour Date YYMMDD 16. NORMAL WORKING HOURS DAY OF DEPARTURE TO FROM 19.

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