INSTRUCTIONS FOR COMPLETING THIS FORM ARE

LEAVE REQUEST/AUTHORIZATION NAVCOMPT FORM 3065 (3PT)(REV. 2-83) INSTRUCTIONS FOR COMPLETING THIS FORM ARE ON THE REVERSE OF PART 3 SEE REVERSE FOR PRIVACY ACT STATEMENT 1. DATE OF REQUEST FORMTEXT 040412 2. FOR ADMIN USE ONLY APPROVAL OF THIS LEAVE IS NOT VALID WITHOUT CONTROL NO. LEAVE CONTROL NO. FORMTEXT 3. SSN FORMTEXT 4. NAME (Last, First, MI) FORMTEXT 5. PAY GRADE FORMTEXT E-6 6. SHIP/STATION FORMTEXT BAGHDAD, IRAQ 7. DEPT/DIV FORMTEXT OSC 8. DUTY SECTION FORMTEXT HQCMDT 9. DUTY PHONE FORMTEXT 10. TYPE OF LEAVE FOR USE OUTUS ONLY 12. MODE OF TRAVEL FORMCHECKBOX REGULAR FORMCHECKBOX SICK FORMCHECKBOX EMERGENCY 11a. Leaving Area of P E R M D U T Y S T A FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX AIR FORMCHECKBOX BUS FORMCHECKBOX SEPARATION FORMCHECKBOX RETIREMENT FORMCHECKBOX OTHER. FORMTEXT 11b. Taking Leave I N C O N U S FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX CAR FORMCHECKBOX TRAIN 13. DAYS REQUESTED FORMTEXT 7 14. FROM (Hour, Date) (YYMMDD) FORMTEXT 040412 15. TO (Hour, Date)(YYMMDD) FORMTEXT 040418 16. NORMAL WORKING HOURS DAY OF DEPARTURE FROM: TO: 17. LEAVE BALANCE. FORMTEXT N/A DAYS AS OF. FORMTEXT N/A 18. LEAVE USED THIS FY FORMTEXT N/A 19. LEAVE PHONE FORMTEXT FORMTEXT DAY OF RETURN FORMTEXT N/A 20. LEAVE ADDRESS FROM: TO: FORMTEXT FORMTEXT 1630 FORMTEXT 0730 FORMTEXT 21. RATION STAUS (Enlisted) FORMTEXT FORMCHECKBOX COMMUTED RATIONS (COMRATS) FORMTEXT FORMTEXT FORMCHECKBOX MEAL PASS NO. FORMTEXT Entitled to EDF meals except during periods of leave SIGNATURE OF APPLICANT RECOMMENDED DATE FORMCHECKBOX YES FORMCHECKBOX NO DATE FORMCHECKBOX YES FORMCHECKBOX NO DATE FORMCHECKBOX YES FORMCHECKBOX NO DATE FORMCHECKBOX YES FORMCHECKBOX NO 23. APPROVED DISAPPROVED REVIEWING OFFICER’S NAME AND SIGNATURE DATE FORMCHECKBOX YES FORMCHECKBOX NO 24. COMMENTS/REMARKS FORMTEXT FORMTEXT FORMTEXT FORMTEXT 25. SHIP OR STATION (Including telegraphic address) FORMTEXT NTTC LACKLAND AFB, TX 78073 FORMTEXT FORMTEXT FORMTEXT 26. REPORT ON EXPIRATION OF LEAVE TO (If other than block 25) FORMTEXT FORMTEXT FORMTEXT FORMTEXT DEPARTED ON LEAVE RETURNED FROM LEAVE GRANTED EXTENSION OF LEAVE ENDING 27a. HOUR FORMTEXT 27b. DATE (YYMMDD) FORMTEXT 28a. HOUR FORMTEXT 28b. DATE (YYMMDD) FORMTEXT 29a. HOUR FORMTEXT 29b. DATE (YYMMDD) FORMTEXT 27c. OOD’S SIGNATURE 28c. OOD’S SIGNATURE 29c. OOD’S SIGNATURE IN CONSIDERATION OF THE MEMBER’S COMPLETION OF A FULL 30. INCLUSIVE FIRST: LAST: 31. NO. OF 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. LEAVE PERIOD TO BE CHARGED (YY) FORMTEXT (MM) FORMTEXT (DD) FORMTEXT (YY) FORMTEXT (MM) FORMTEXT (DD) FORMTEXT DAYS FORMTEXT I CERTIFY THAT THE ABOVE IS CORRECT AND PROPER TO THE BEST OF MY KNOWLEDGE CERTIFYING OFFICER’S TYPE NAME/RANK/TITLE FORMTEXT 33. CERTIFYING OFFICER’S SIGNATURE FORMCHECKBOX WHITE COPY FORMCHECKBOX PINK COPY FORMCHECKBOX GREEN COPY