Form approved by Comptroller General,
April 26, 1950
S-1
*See Art. B-2305 BuPers Manual
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REPORT PERS-82-79
INDIVIDUAL ORDER TO ADJUST PAY RECORD
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1. LEAVE RATIONS OR LOSS OF PAY DUE TO ABSENCE
WITH LEAVE: AOL OR AWOL period, if any, excused as unavoidable
WITHOUT LEAVE: Not excused as unavoidable
HOUR
DATE
DEPARTURE
WITH LEAVE: AOL period, if any, not excused as unavoidable
OVER LIBERTY: Not excused as unavoidable
LEAVE OR LIBERTY EXPIRED
RETURNED TO NAVAL JURISDICTION
*Credit leave rations and/or check pay in accordance with current directives*
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2. CHANGE RATE: TO ___________________________ (Rate)
FROM ___________________________ (Rate)
EFFECTIVE ___________________________ (Date change effected)
AUTHORITY ___________________________
AUTHORITY RECEIVED ___________________________ (Date)
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3. CHANGE IN SERVICE FOR PAY PURPOSES:
OTHER SERVICE**
YEARS
MONTHS
DAYS
NAVAL SERVICE
ON ___________________________ (Date)
COMPLETED ___________________________
NET SERVICE OF ___________________________
**\*\*Career Compensation Act of 1949. BuPers statement of service filed in service record.**
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4. COMMUTED RATIONS: FROM ___________________________ (Date)
TO ___________________________ (Date)
*Permission to mess separately has been granted. Commutation of rations to a mess or subsistence in kind has not and will not be authorized or furnished for this period.*
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5. SUBSISTENCE ALLOWANCE: FROM ___________________________ (Hour and date)
TO ___________________________ (Hour and date)
AT $ ___________________________ per day
*Rations in kind not available or furnished for this period.*
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6. QUARTERS ALLOWANCE: FROM ___________________________ (Date)
TO ___________________________ (Date)
AT $ ___________________________ per mo.
AND/OR
AT $ ___________________________ per day
*No Government quarters available.*
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7. MISCONDUCT: The below-named individual has been incapacitated for duty from ___________________________ (Date of admission)
TO ___________________________ (Date of discharge)
as a result of his own:
☐ INTEMPERATE USE OF DRUGS
☐ INTEMPERATE USE OF ALCOHOLIC LIQUORS
SIGNATURE, RANK, AND TITLE OF M. O. (Sign original and duplicate)
SHIP OR STATION OF M. O.
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8. MISCELLANEOUS PAY ORDERS *(See reverse of part 4 for instructions)*
APPLICATION FOR SOCIAL SECURITY ACCOUNT NUMBER CARD MADE 25 OCT 1956
ISSUED SOCIAL SECURITY NO. 540-46-3224
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The Disbursing Officer is authorized and directed to adjust pay record of the below-named individual for the reason and period stated above.
NOTE: VOID IF MORE THAN ONE ITEM IS COMPLETED
EFFECTIVE FOR ITEM (Number)
SIGNATURE
RANK AND TITLE
BY DIRECTION
C. O. ORDER NO.
8 ONLY
[Signature]
F. M. HALL, LCDR, USN, PERSONNEL OFFICER OF THE CO
1461-57
SHIP OR STATION
NATECHTRAU, NAS, PENSACOLA, FLORIDA
NAME (Last)
NEWHOUSE
(First)
Delbert
(Middle)
Clement
SERVICE NO.
177283
RATE
CHPHOT, WA
BRANCH AND CLASS
USN
D. O. SYMBOL NO.
A7222
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INDIVIDUAL ORDER TO ADJUST PAY RECORD
NAVPERS-601/NAVSANDA-515 (REV. 3-51)
GPO 62-16-02078-2 7 □
PART 4—FORWARD TO BUPERS.
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