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__Yes __No (IF YOU ANSWERED ' YES' TO ANY OF THE ABOVE, DISCONTINUE APPLICATION AND LEAVE PREMISES IMMEDIATELY.

_________________________________________________________Applicant's Signature (that means sign your name, moron!

I request permission for a leave of absence from the highest authority in my life for the following period: Date: Time of departure: Time of return: Location: From: To: Beer Wine Liquor: Total Should permission be granted, I do solemnly swear to only visit the locations stated below, at the stated times.

I agree to refrain from hitting on or flirting with other women.

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