LSJ Employees, LLC Mailing Address: 6100 Red Hook Quarter B3 St. Thomas, VI 00802-1348 General contact information Tel: 340-775-8100 Fax: 340-775-8108 E-mail: |sj.island@ Accounts payable department contact information Fax: 340-775-2528 Vacation / Leave Form Dates of Requested: Date of First Day of Vacation: |Monday March 18th 2013 Date Return to Work: Monday April 8th 2013 Total Number of Days: ne ae ee ae ne ng en ae Te Type of Leave: @ Vacation with Pay C Leave without pay C Personal Sick Leave C Other If Other Explain: |Holidays:: Christmas 2012, New Years 2012, Easter Friday, Easter Monday (leave AM 18th, return PM 7th) List of all contact information: -— 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 ah eens Sais

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LSJ Employees, LLC Mailing Address: 6100 Red Hook Quarter B3 St. Thomas, VI 00802-1348 General contact information Tel: 340-775-8100 Fax: 340-775-8108 E-mail: |sj.island Accounts payable department contact information Fax: 340-775-2528 Vacation / Leave Form Name: Date of Request: | 1/23/13 Dates of Requested: Date of First Day of Vacation: |Monday March 18th 2013 Date Return to Work: Monday April 8th 2013 Total Number of Days: Leave Days:[11__ | Weekend Days|6 | Holidays: | Personal/Sick:[ | Days Remaing:|30 days _| Type of Leave: @ Vacation with Pay C Leave without pay C Personal Sick Leave C Other If Other Explain: |Holidays:: Christmas 2012, New Years 2012, Easter Friday, Easter Monday (leave AM 18th, return PM 7th) List of all contact information: Phone: Cell: 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 aie fe EFTA00305860

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