LSJ Employees, LLC General contact information Tel: E-mail: Accounts payable department contact information Fox: Vacation / Leave Form Name: Thomas J Melnick ee Date of Request: (5/11/12 | Dates of Requested: Date of First Day of Vacation: |June 8th 2012 ] Date Return to Work: July 2nd 2012 } Total Number of Days: Leave Days: |16 _| Weekend Days:/8 | Holidays: Personal / Sick : Days Remaing:/0 days _ | Type of Leave: @ Vacation with Pay C Leave without pay C Personal Sick Leave C Other if Other Explain: | 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 Approved: EFTA00593602