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f —:ZV <br />FC: 4770 <br />REQUEST AND AUTHORIZATION FOR ACTIVE DUTY TRAINING/ACTIVE DUTY (OUR <br />(THIS FORH IS SUBJECT TO THE PRIVACY ACT OF 1974- USE BLANKET PAS - AF FORM 11) <br />1. FROM $11 .I A..ipm,.n) <br />(((T]1 <br />44699 <br />L AIP11OYI16G 7►hF1�Al (Nr., OrwM, SI/trfw �d D.N) <br />i(J/]�..C-.AL4 <br />BY 3ROER OF 'fNE SECRETARY <br />MCCHORD APB WA <br />VICKI S. KTN SSCT, USAFR 12 Jul 85 <br />Of THE AIR FORCE <br />S. GRADE, NAME (La.G pint, W). SSAN <br />a. PRESENT ADDRESS COO <br />5. SECURITY CLEARANCE <br />SSG PIERRE, ROBERT R. <br />8016 Beverly Blvd <br />a.DAFSC <br />7. <br />073-44-5168 <br />Everett, WA 98202 <br />CORPO►ATE LIMITS OF DUTY STATION <br />I r 1 ART <br />CRR <br />B. PURPOSE OF TOUR // <br />5. MNDY-E%P- <br />AUTH•N0. <br />(a) 0 ANNUAL IN) [�5CHOOL (n) EX]SPECIAL ADT O(MPAI MAN -DAY TOUR MAN-DAY1 <br />COS <br />10. 1s ORD[RLD TO AO FON <br />11. 1 r, ■o, <br />1 Of otMr d,w, Nnll et."I, CVf 1. nWrl.d) <br />ons.) Col .rq " <br />0']l/ 85E�804 <br />5 <br />_PAYS IMCL RyrItKTVL TIYC <br />IL RELEASE DAY",,atol DO <br />UNIT OF ATCN Is THE COMDR E%CR IM A RT MARTIAL <br />CONVENING AUTH OVERRCChord AFB RA 9843E-5000 <br />YAO INITIALS CPU <br />COI <br />Ia. TRAVEL DAYS AUTHORIZED <br />15. COMMUTE ON <br />16, VOC STATEMENT C V <br />Tt. PRIMARY DEPN <br />Cob <br />❑Costa Oln AT TVL DA' <br />QYESIa LRJNorn <br />was �i Nn <br />ROBINE-(WIFE) <br />16. VARIABLE TOUR STATEMENT <br />M SUSJ TO APPR BY PROPER AUTH, IF MDR REMAINS ON SPECIAL /SCHOOL YOUR (RPA) IN EXCESS OF DAYS SHOWN, THE ORDER NEEn <br />NOT DE AMENDED IF NUMBER OF DAYS SHOWN IN BLOCK101S LESS THAN SO AND DAYS SNOW1i.IS NOT EXCEEDED BY 100 PERCENT OR <br />lU <br />7 DAYS, WHICHEVER IS LESS. 1N Nn EVENT WILL THESE ORDERS EXCEED A TOTAL OF DAYS. <br />rw .pclllc n,aaew) <br />19. TMO CAT-INO CP3 <br />Be. TOUrMNO CPT <br />21. BAS CODE <br />2L AUT NORITY: COP AFR ]Fel <br />41 <br />JACFT MAINT TNG <br />D B <br />27. NOR'& TVL VOU AMD COMPL STMT OF YOUR TO BE FILED WITHIN 5 WORKDAYS AFTER TOUR COMPL. ATCH CERTIFIED COPY OF <br />OF POV IS SPECIFICALLY AUTH, TRAVELER'S DEP <br />ORDER TO TVL VOU IF TOUR IS EXTENDED OR TERMINATED. UNLESS USE <br />IS LTD TO 1 DAY BEFORE AMD 1 DAY AFTER TOUR VT. TVL AT OTHER TIMES AMD DEVIATIONS FR DIRECT TVL ARE AT <br />TRAVELER'S OWN RISK. UTILIZE GOVT OTRS IF AVAL. <br />2/. TOTAL AT DAYS USED THIS ►Y <br />2b. TOTAL AT TR& (,and trip.) USED THIS FY <br />2L REMARKSIAMU-SSOAH) Turn in all promotional items, for example, gifts, bonus tickets, ate to the AFO. <br />Since your per diem payment is based on available government quarters and mess, contact <br />base billeting office to see if they are available. Member must pay TDY surcharge at <br />military facilities. <br />p, CHARGEABLE TO ((cTable SD <br />P A A 5753700 505 6272 P727.01 .02/.0S 38010 <br />T RAVELP CP2 <br />s. DISTRIBUTION 29. RCSCRVL ORDER NO. CPY I W. DATE <br />1-MAW/MAP r TNLc tw <br />SL SIGNATU NT OF AUTHENTICATING OFFICIAL fT.6le ]]) <br />41%C�Ji <br />St. DESIGNATION AND LOCATION OF HEADQUARTERS CIXV01 <br />OF AIR FORCE <br />E��[r�'e��y��w�- <br />HO 4A6TMENT <br />BS (AFRES) <br />McChord AFB, RA. 98438-6004 LEO N Mr 1NLH� SOT, UiAFR (ART) <br />Chia W Administ on <br />SL STATEMENT OF TOUR OF DUTY ��' e,. c �% <br />MODE <br />LOCATION <br />UR <br />HOWIG <br />DATE <br />MONTH <br />LOCATION <br />HOUR <br />I <br />DATE <br />MONTH <br />OF <br />TRAVEL <br />( <br />DEPART <br />ARRIVE <br />DEPART <br />ARRIVE <br />I earlier that l haea eompiisd with abon ondw, that the "Ia an Just end true In all nepects, and /Aar I hers not recslvad ps nont, I <br />ndntynfdner (� the Oorematwll of the <br />BrNLor eedlfr that ill was In WIMPI of A PMSJM, a diesbUlty eoapareatlmr, or per <br />United Stales, I he" umpleted AP from 1962 to waiver the applicable l7&/-Ba14' and 1(a Fodwal semlereq I was on authodpod leave <br />drrlrg the period stated In No &Bove order. My spouse (dlcO (did not) draw depn BAQ. I (.an) (an, not) elided In single BAQ; <br />(am) (aer, not) on flyin4 status. 11 this lour was extended under the variable four pro vision, It was with my Prior Anowiadfa and consent, <br />USU GER-S SIGNATURE <br />DATE <br />CERTIFICATION <br />I Cattily that the above member reported for drty at hours en and was released hem arty at —noun on <br />CERTIFYING OFFICIAL'S NAM[, GRADE. AND TITLE <br />SIGNATURE <br />DATE <br />AFRES )FOR p 938 R[PLACU AFRES FORMS DWI TEST). SEP 03, AND 175, AUG 03, WHICH ARE OBSOLETE. 446ABS Overprint <br />