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November 2,
November 2, 2011
2011

Mr. Employer
Mr. Employer
123 Main
123 Main Street,
Street, Suite
Suite #1
#1
Anytown, ST
Anytown, ST 12345
12345

Ms. Maternity
Ms. Maternity Leave
Leave
345 South
345 South Street
Street
Anytown, ST 12345
Anytown, ST 12345

Dear Mr.
Dear Mr. Employer,
Employer,

II recently
recently learned
learned from
from my
my doctor,
doctor, Mr.
Mr. Physician, that II am
Physician, that am expecting
expecting and
and due
due to
to deliver
deliver in
mid-August.
in mid-August. Because
Becauseof of
this, I am
this, writing
I am to to
writing provide you
provide with
you notice
with that,
notice beginning
that, onon
beginning August
1st, 2012,st I will be taking maternity leave.
August 1 , 2012, I will be taking maternity leave.
Pursuant to the Family and Medical Leave Act of 1993, I anticipate taking the full 12 weeks
available to
Pursuant to the
me Family
for maternity leave. ILeave
and Medical will beActreturning
of 1993, toIwork on November
anticipate taking the 1,full 12 I
2012.
understand
weeks that these
available to me weeks are unpaid.
for maternity leave.Please
I will beletreturning
me knowtowhatworkpaperwork
on November or other
1,
2012. I understand that these weeks are unpaid. Please let me know what paperwork orit to
information you require regarding my pregnancy and maternity leave, and I will provide
you asinformation
other soon as possible,
you require withregarding
delivery promised
my pregnancy no laterandthan July 1stleave,
maternity , 2012.and I will
provide it to you as soon as possible, with delivery promised no later than July 1st, 2012.
Prior to my beginning maternity leave, I will make all necessary arrangements for my
co-workers, supervisors and assistants to perform the tasks of my job during my absence.
Prior to my beginning maternity leave, I will make all necessary arrangements for my
Although I do
co-workers, not anticipate
supervisors andexperiencing
assistants to any problems
perform with of
the tasks this
mypregnancy,
job during should
my any
complications
absence. arise, it may be necessary for me to take leave earlier than expected. In this
circumstance, I will provide you with as much notice as possible as well as any physician
AlthoughorI do
records information you request.
not anticipate I understand
experiencing that, even
any problems withshould I take my should
this pregnancy, maternity
anyleave
early, I am still only entitled to 12 weeks of unpaid federal leave.
complications arise, it may be necessary for me to take leave earlier than expected. In
this circumstance,
Please let me knowI will provide
if you have you
any with as much
questions. I amnotice
happyas to
possible as well
meet with you as any
to discuss them
and provide
physician you with
records any documentation,
or information you request. including a note from
I understand that, my physician.
even should I take my
maternity leave early, I am still only entitled to 12 weeks of unpaid federal leave.
Thank you and best regards,
Please let me know if you have any questions. I am happy to meet with you to discuss
Ms. Maternity
them Leave
and provide you with any documentation, including a note from my physician.

Thank you and best regards,

Ms. Maternity Leave