Elections System of the Virgin Islands
Sunny Isle Shopping Center, Christiansted, St. Croix, V.I. (340) 773-1021 
9200 Lockhart Gardens, St. Thomas, V.I. (340) 774-3107 
 P.O. Box 1499  Kingshill  St. Croix  U.S. Virgin Islands 00851 / P.O. Box 6038  St. Thomas  U. S. Virgin Islands 00801 
EXAMINATION & COPY OF RECORDS 
TERRITORY OF THE VIRGIN ISLANDS 
District of St. _____________________  
Name: _______________________________  
Date: ______________________ 
Mailing or Physical Address: ______________ 
Telephone#: ________________ 
______________________________________ 
I am a register voter: Yes  No  
Number of Copies Requested:________ 
Name of Documents to be examined: ________________________________________ 
______________________________________________________________________ 
Purpose of examination of document(s)______________________________________ 
Fee due to the Election System of the Virgin Islands: $___________ 
I understand that I must abide by the procedures that govern the examination and copying of records, no 
records are to be removed from the viewing area, and no records are to be written on our altered in any 
way. If this office should all of sudden need to refer to records, which are being viewed by a person, then 
the records are immediately returned upon request. I, the undersigned, declare under perjury that the 
information furnished herein is correct and complete and that I will only utilize the information for the 
purpose outline in the request, nor will I disposed of it in an unauthorized manner as determined by the 
Election System of the Virgin Islands. 
_________________________ 
Signature of Requestor 
Reviewed by: 
_____________________________________________________________________ 
ELECTION OFFICIAL 
ELECTIONS SYSTEM OF THE VIRGIN ISLANDS FORM Revised 0008/2010
SIGN