Elections System of the Virgin Islands 
Sunny Isle Shopping Center, Christiansted, St. Croix, V.I. (340) 773-1021 
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 
TO           : 
ELECTIONS SYSTEM OF THE VIRGIN ISLANDS 
P.O. BOX 1499/P.O. Box 6038 
KINGSHILL, VIRGIN ISLANDS 00851-1499/ ST. THOMAS, VI 00804
EMAIL: esvi.info@vi.gov
FROM  
 :  
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___________________________________________ 
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DATE       : 
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SUBJECT:  
REQUEST FOR REINSTATEMENT OF REGISTRATION. 
PURSUANT TO TITLE 18 SECTION 110. 
PLEASE BE ADVISED THAT I AM REQUESTING THE REINSTATEMENT OF MY 
REGISTRATION.  I AM REGISTERED TO VOTE ONLY ON _________________, U.S. VIRGIN 
ISLANDS. MY PLACE OF RESIDENCE IS: 
    ________________________________________________________ 
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MY MAILING ADDRESS IS: 
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  SIGNATURE OF ELECTOR AND DATE 
FOR OFFICIAL USE ONLY 
YOUR REQUEST FOR REINSTATEMENT OF YOUR REGISTRATION HAS BEEN GRANTED BY THE 
SUPERVISOR OF ELECTIONS. 
ELECTIONS SYSTEM OFFICES ARE AT SUNNY ISLES SHOPPING CENTER UNIT 26, ST. 
CROIX, LOCKHART GARDENS, ST. THOMAS, OR MARKET PLACE THIRD FLOOR, ST. JOHN.  FOR 
ADDITIONAL INFORMATION CONTACT (340) 773-1021 OR (340) 774-3107. 
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 ELECTION OFFICIAL’S SIGNATURE AND DATE 
SIGN
SIGN