LSJ Employees, LLC Mailing Address: 6100 Red Hook Quarter B3 St. Thomas, VI 00802-1348 General contact information Tel: ax: 340-775-8108 E-mail: Accounts payable department contact information Fax: 340-775-2528 Vacation / Leave Form Name: Date of Request 5/11/12 Dates of Requested: Date of First Day of Vacation: Total Number of Days: Leave Days: 16 June 8th 2012 Weekend Days: 8 Holidays: Date Return to Work: Personal / Sick: Type of Leave: 07 Vacation with Pay C' Leave without pay r Personal Sick Leave r Other If Other Explain: July 2nd 2012 Days Remaing: 0 days List of all contact information: Phone: Cell: Email: The following must be verified with Estate Manager 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: EFTA01110219