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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 J` <br />Insert number of Hours requested in space provided below: <br />VACATION <br />COMPENSATORY TIME <br />SICK TERMINATION MILITARY JURY DUTY <br />(Accrued Vacation) <br />LEAVE OF ABSENCE M CcrLE z_\--\ i \ F F \-.) E ( 3 MCA `1 <br />(Explain) <br />OTHER h— \Q99 Th <br />LEAVE WILL BEGIN: I \Ok.:1. 1FtJ. Z$, \C\ck\ LEAVE WILL END:Mc'A -A <br />(Day) (Date) <br />Signed <br />LEAVE RECORD: VL SL CT <br />A OVED BY: <br />Accrued Leave <br />Leave Requested <br />Balance <br />(Day) <br />RPMv\- 7�,vRCl <br />(Date) <br />(Employee) <br />(Depa ment Head) <br />Page 72 <br />