LSJ Employees, LLC Mailing Address: 6100 Red Hook Quarter 133 tit. Thomas, VI 00802-1348 General contact information Tel: 340-775-8100 Fax: 340-775-8108 E-mail: Accounts payable department contact information Fax: 340-775-2528 Vacation / Leave Form Name: @fit I ci)) A Date of Request:i 15 rocv c ot; Dates of Requested: Date of First Day of Vacation: Total Number of Days: Al,a7,ab Leave Days: 3 Type of Leave: —rues 31 Aran Date Return to Work: 30431 21 t Apr Wars 11-fri Weekend Days: / Holidays: 2. Personal / Sick : I Days Remaing: y Vacation with Pay C Leave without pay If Other Explain: C Personal Sick Leave C Other List of all contact information: Phone: Cell: Email: E L The following must be verified with Estate Manager I 1. The number of vacation days you have taken. 2. The number employee in your division / department that are leave at the same time Approved: EFTA01091902