REQUEST AND AUTHORITY FOR LEAVE/PASS "JJI.i....I! (Jj! y.\Ja 1. NAME (Last, First, Middle Initial) \("""il

REQUEST AND AUTHORITY FOR LEAVE/PASS "JJI.i....I! (Jj! y.\Ja 1. NAME (Last, First, Middle Initial) \("""il 2. CONTROL NUMBER ....;t.....:..'i\,.s)\ 3. NIA# .;J.i;J\,.sJ 4. ENLIOFF .1.;L.<. I/.; 5. DATE e:<.J\ 6. LEAVE ADDRESS (Street, City, State, ZIP Code and Phone No.) u1 ,.s.JJ 6...1\ J I (""'I,t)....:Ji' I.JI. 7. TYPE OF LEAVE :°.JJu..J1 t-'" 8. ORGN, STATION, PHONE NO. o,o",}1 J;u.,...]1 J:WOWI (""'I 9. NUMBER DAYS LEAVE/PASS - Ordinary ';JI - Emergency _cs)y.a.. Other .,;00.1 y;.wJ °.JJu..J1 41 JJ<> 10. DATES ° jJu..J1 41 e:<):J a. ACCRUED b. REQUESTED c. ADVANCED d. EXCESS a. FROM J <.JAr' TO 11. SIGNATURE OF REQUESTOR ylbJ\ Ji. t;#.fJ 12. SIGNATUREAND TITLE OF APPROVING AUTHORITY ,j\ J\ :i..p.J J t;#.fJ 13. DEPARTURE"JJti.Jt a. DATE i:J.J1:lI1 b. TIME ":';)1 c. NAMEITITLE/SIGNATURE OF DEPARTURE AUTHORITY °JJu..J1 LP JI :i..pJJ t;#.fJ (""'I 14. EXTENSION J,jJ..J1\ a. NUMBER OF DAYS b. DATE APPROVED c. NAMEITITLE/SIGNATURE OF APPROVAL AUTHORITY I J\ :i..pJJ t;#.fJ 4"i1 JJ<> '-.iilyJl e:<J; 10. REIUKN tp..J'1 a. DATE e:<.J1 b. TIME uo}1 c. NAMEITITLE/SIGNATUREOF RETURN AUTHORITY t.J>-.)1LP JI :i..pJ J t;#.fJ J (""'I "- 16.REMARKS: IF SERVICEMAN CANNOT RETURN TODUTYSTATION HEIS TOREPORT TOTHE NEAREST RECRUITING STATION FOR ASSISTANCE oJ<>L...JJ JS..)A ..".)1 J.."lA\ .&.,!lc. y;...j .u,o",J! oJ."..J1 \ ,J I! :<.:"Lb)W1 :.)1 :jJ.<.JAt.1 4'i\ Chargeable leave is from to I understand the dates and time of my leave authorized. I understand that I could be subject to recycle for missed training. I understand that if I fail to report on time is grounds for recycle or dismissal. , I understand that all advance pay will be deducted from my pay. I understand all the stated above, and will inform NIATC if any difficulties arise or report to the nearest Recruiting Station for assistance. .l..;-IlAl14 ~ C~\J J~\ ci~\J r'~\ ~i ui '1.:I:!.)Jl!\ ~ uw.:i \~!ojj-+1i ~i u~ ~i ui u~ JA4.1\ ci~\ ~ o.)J~4J~4 ~ \~! ~i ~i ui .J,;.b3\ Ji o.)J~\ OJ~! 1.4! U!J04J ~J ~ w.,s:i .~\)\ 6-t ~ u~ t..Ji.. ~~i '1l1\ JLJ\ wi ~i ui ~4~ Ji tgj!~ ~JJa. ~b. ~ J o*-i [.)Ji 1.4 JS ~\ ui .O$.t J.I \~1~-: 4Jw 1..;-1)\ ~\ Ji ~\ OJ! .I!.;A.\ u~ Printed Name 1"'""~1 Signture Authorized Advanced Pay Amount $- eft y11 4..i(~\ F.\ Ray A Combs II LTC, United States Army CMATT