LSJ, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802-1348 E-mail: Vacation / Leave Form Name: Date of Request: |11/27/11 Dates of Requested: Date of First Day of Vacation: |December 12th, 2011 Date Return to Work: [December 19th, 2011 Total Number of Days: Leave Days: |2 Weekend Days|2 | Holidays: Personal / Sick: ee Days Remaing:|58 days Type of Leave: C Vacation with Pay C Leave without pay C Personal Sick Leave C Other if Other Explain: |Holidays - Labor Day, Thanksgiving Day, Thanksgiving Friday List of all contact information: Phone: MH | Celt: i 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: EFTA00305862

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LSJ, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, Vi 00802-1348 Tel: 340-775-8100 Fax: 340-775-8108 E-mail: Vacation / Leave Form Date of Request: i V27/11 Dates of Requested: Date of First Day of Vacation: [December 12th, 2011 Date Return to Work: December 19th, 2011 Total Number of Days: Leave Days: |2 | Weekend Days:|2 Holidays: 3 | Personal / Sick : | Days Remaing:|60 days Type of Leave: C Vacation with Pay C Leave without pay C Personal Sick Leave C Other If Other Explain: |Holidays - Labor Day, Thanksgiving Day, Thanksgiving Friday 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: EFTA00305863