OFFICE OF THE SUPERVISOR OF ELECTIONS



STATEMENT OF ORGANIZATION



Political Committee Registration re: 18 Virgin Islands Code 904:

Each political committee which anticipates receiving contributions or making expenditures



during the calendar year in a aggregate amount exceeding five hundred dollars ($500.00) shall

file with the Supervisor of Elections a statement of organization.



1. NAME AND ADDRESS OF COMMITTEE:



Z NAMES AND ADDRESS OF AFFILIATED OR CONNECTED

ORGANIZATIONS:



3. PURPOSE OF COMMITTEE:



4. NAMES, ADDRESSES AND TITLES OF PRINCIPAL OFFICERS OF THE

COMMITTEE:

5. NAMES, ADDRESSES AND TITLES OF CUSTODIAN (S) OF ALL BOOKS AND

ACCOUNTS:



6. NAMES, ADDRESSES, OFFICE SOUGHT OR OFFICE ASSISTING AND

PARTY AFFILIATION OF EACH CANDIDATE THE COMMITTEE IS

SUPPORTING OR OPPOSING, IF THE PURPOSE OF THE COMMITTEES IS

TO OPPOSE A CANDIDATE:



(a) SUPPORTING:



(b) OPPOSING:

BRIEF STATEMENT RELATIVE TO COMMITTEE:



(a) IS THE COMMITTEE A CONTINUING ONE ?



(b) WHEN WAS THE COMMITTEE FORMED AND IS IT REGISTERED

WITH THE OFFICE OF THE LT. GOVERNOR AND INTERNAL

REVENUE SERVICE ?



(c) WHEN IS THE COMMITTEE TO BE DISSOLVED ?



(d) IN THE EVENT OF DISSOLUTION OF THE COMMITTEE WHAT

WILL BE THE METHOD OF DISPOSITION OF THE SURPLUS FUNDS?



(e) PLEASE PROVIDE ANY OTHER INFORMATION PERTINENT TO THE

ORGANIZATION OF THE COMMITTEE:



LIST ALL BANKS AND ACCOUNT NUMBERS, SAFETY DEPOSIT

BOXES, OR OTHER REPOSITORIES USED OR TO BE USED BY THE

COMMITTEE:

STATEMENT OF CHAIRMAN AND TREASURER OF THE COMMITTEE:



We hereby jointly and individually declare that we have examined this

Statement of Organization and to the best of our knowledge and belief the

information provided herein is true and correct and complete.



Type or print name of Chairman Type or print name of Treasurer

Signature of Chairman Signature of Treasurer

Date Date

GOVERNMENT OF



THE VIRGIN ISLANDS OF THE UNITED STATES



OFFICE OF THE SUPERVISOR OF ELECTIONS



APPOINTMENT



MRS. CAROLINE FAWKES

Supervisor of Elections



Election System of the Virgin Islands

P.O. Box 1499



Kingshill, St. Croix



Virgin Islands 00851-1499



DEAR Mrs. Fawkes:



Candidate / Chairman Name



recommend the appointment of



for the



to the position



Name of Appointee



Name of Campaign Organization



Effective on and after



Date



Sincerely,



Candidate / Chairman

GOVERNMENT OF



THE VIRGIN ISLANDS OF THE UNITED STATES



OFFICE OF THE SUPERVISOR OF ELECTIONS



APPOINTMENT



MRS. CAROLINE FAWKES

Supervisor of Elections



Election System of the Virgin Islands

P.O. Box 1499



Kingshill, St. Croix



Virgin Islands 00851-1499



DEAR Mrs. Fawkes:



Candidate / Chairman Name



to the position



recommend the appointment of



for the



Name of Appointee



Name of Campaign Organization



Effective on and after



Date



Sincerely,



Candidate / Chairman

GOVERNMENT OF

THE VIRGIN ISLANDS OF THE UNITED STATES



OFFICE OF THE SUPERVISOR OF ELECTIONS



ACCEPTANCE

District of , 20

Campaign Committee of , SS#

Madam:-

| hereby accept the appointment tendered me by

Candidate/Chairman

Name .

To the position of , dated , 20

Respectfully,

Appointee



Oath of Office



Having been appointed



I, ,do solemnly swear or affirm

that | will support the laws of the United States applicable to the Virgin Islands and the



laws of the Virgin Islands; that | take this obligation freely, without any mental



reservation or purpose of evasion, and that | will well and faithfully discharge the duties of

the office on which | am about to enter, SOQ HELP ME GOD.



Signature



District of _

Virgin Islands of the U.S.A. SS:



Sworn to and subscibed before me this day of ,20



Efective ,20



Notary Public

GOVERNMENT OF

THE VIRGIN ISLANDS OF THE UNITED STATES



OFFICE OF THE SUPERVISOR OF ELECTIONS



ACCEPTANCE

District of , 20

Campaign Committee of , SS#

Madam:-

| hereby accept the appointment tendered me by

Candidate/Chairman

Name ,

To the position of , dated , 20

Respecttully,

Appointee



Oath of Office



Having been appointed



I, ,do solemnly swear or affirm

that | will support the laws of the United States applicable to the Virgin Islands and the



laws of the Virgin Islands; that | take this obligation freely, without any mental



reservation or purpose of evasion, and that | will well and faithfully discharge the duties of

the office on which | am about to enter, SO HELP ME GOD.



Signature



District of ___

Virgin Islands of the U.S.A. SS:



Sworn to and subscibed before me this day of ,20



Efective ,20



Notary Public