LSJ Employees, LLC Mailing Address: 6100 Red Hook Quarter 113 St. Thomas, VI 00802-1348 General contact information Tel: 340-775-8100 Fax: 340-775-8108 E-mail: Isj.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 Total Number of Days: Leave Days: 11 Type of Leave: Weekend Days: 6 Date Return to Work Monday April 8th 2013 Holidays: k I Personal / Sick : Days Remaing: 4' Vacation with Pay C Leave without pay If Other Explain: Personal Sick Leave C Other 30 days Holidays:: Christmas 2012, New Years 2012, Easter Friday, Easter Monday (leave AM 18th, return PM 7th) 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: EFTA00305858