Request for state active duty




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UNCLASSIFIED//FOR OFFICIAL USE ONLY


DMNA FORM 1160 REQUEST FOR STATE ACTIVE DUTY

1. NAME:____________________________________________________________________


2. SSAN:___________________________ 3. RANK/GRADE:_______________________
4. UNIT:_____________________________________________________________________
5. START DATE:______________________ 6. END DATE:___________________________
7. NUMBER OF DAYS:______________________ 8. REPORT TIME:___________________
9. REPORT TO:_______________________________________________________________
10. PURPOSE OF DUTY:________________________________________________________
11. HOR:____________________________________________________________________
12. CHECK MAILING ADDRESS: _________________________________________________

(IF OTHER THAN HOR)


13. MODE OF TRAVEL:_________________ 14. PEBD (PAY DATE):__________________
15. MARITAL STATUS:____________________ 16. WITHHOLDING:___________________
17. FLIGHT PAY: _____________________________
18. ADDITIONAL INFORMATION: ________________________________________________
19. REQUESTED BY: _____________________________

UNIT COMMANDER (RANK/SIGNATURE/DATE)


20. APPROVED BY: _____________________________

COMPONENT (SIGNATURE/DATE)


21. APPROVED BY: J3 DO _____________________________

(SIGNATURE/DATE)


22. APPROVED BY: DIRECTOR _____________________________

BUDGET AND FINANCE (SIGNATURE/DATE)


23. APPROVED BY: _____________________________

CHIEF OF STAFF/TAG (SIGNATURE/DATE)




FORM 1160 REQUIRED FOR ALL NON-EMERGENCY SAD. FORM REQUIRED FOR ALL GENERAL OFFICERS/FLAG OFFICERS (07 & ABOVE) DURING EMERGENCY OPERATIONS

DMNA FORM 1160 (10 MAY 99)




STATE ACTIVE DUTY

CERTIFICATE OF PERFORMANCE (COP)


NAME: ______________________________ SSAN: _________________ GRADE: ____

UNIT: ____________________________________________________________________
CHECK MAILING ADDRESS: ______________________________________________

______________________________________________

______________________________________________

PURPOSE: _______________________________________________________________

PERIOD OF DUTY: ____________________________ NUMBER OF DAYS: ______

REMARKS: ______________________________________________________________


( ) 1. I certify that I have personal knowledge or have personally verified that the duty requested above has been performed and is correct.
( ) 2. I certify that I have personal knowledge or have personally verified that the duty requested

above has been performed. The above pen and ink changes reflect changes/corrections to the information listed on the DMNA Form 1160.
( ) 3. I certify that all information is correct, however, the date(s) of performance are different than originally requested on the DMNA Form 1160 and are corrected as follows:
___________________________ to ___________________________
( ) 4. The duty requested above was not performed. Request revocation of above referenced

request or order.

____________________ ____________________________________

Date of Certification Certifying Official




R-1-C-

UNCLASSIFIED//FOR OFFICIAL USE ONLY


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