LSJ, LLC 6100 Red Hook Quarters Suite 8-3 St. Thomas, VI 00802-1348 Tel: ax: 340-775-8108 E-mail: Vacation / Leave Form Name: Date of Request T-A.OO74s. rY-1 air.) tc. i is 3/19 // Dates of Requested: Date of First Day of Vacation: Total Number of Days: Date Return to Work Leave Days: imp) Weekend Days: a Holidays: Personal / Sick: Days Remainfirl Type of Leave: r<acation with Pay r Leave without pay C' Personal Sick Leave C' Other If Other Explain: 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: EFTA01130132