LSJ, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802-1348 Tel: Fax: E-mail: Vacation / Leave Form Name: !Thomas Melnick Date of Request: [12/02/11 Dates of Requested: Date of First Day of Vacation: 'December 24th, 2011 Date Return to Work: 'January 11th, 2012 Total Number of Days: Leave Days: I10 Weekend Days:F Holidays: FT Personal / Sick: I Days Remainwl 0 days Type of Leave: C Vacation with Pay ' Leave without pay C Personal Sick Leave C Other If Other Explain: Holidays : Christmas Day, New Years Day 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: EFTA01110061