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CITY OF LITTLE CANADA <br />REQUEST FOR LEAVE <br />Request is hereby made for the following leave -- WITH PAY WITHOUT PAY yr- <br />Insert number of Hours requested in space provided below: <br />VACATION SICK TERMINATION MI LITARY JURY DUTY <br />(Accrued Vacation) �. <br />COMPENSATORY TIME LEAVE OF ABSENCE ,3 0 - %u,-N. /J// I2 <br />) (Explain) <br />OTHER /a,,3 M4Vt %% l / d" A ikgzif <br />' <br />LEAVE WILL BEGIN: / - /S- 9/ LEAVE WILL END: 3-071-9/ <br />(Day) (Date) (Day) <br />(Date) <br />Signed /G .� -) <br />(Employee) <br />LEAVE RECORD: VL SL CT <br />Accrued Leave <br />Leave Requested <br />Balance <br />APPROVED BY: <br />(Department Head) <br />Page 42 <br />