OFFICE OF THE LIEUTENANT GOVERNOR    
NOTARY DIVISION 
     5049 Kongens Gade • Charlotte Amalie, Virgin Islands 00802 • 340.774.2991 ext 4120 
 
  
    Request Form for Apostille or Certificate of Authentication        Fee $ 30.00 
      Person Requesting Service:                                                                                                                      
First Name:                                                                        Last Name:                                              Date:  
 
Names listed on the Document  
First Name:                                                                      Last Name:  
 
Name of Firm or Organization:   
 
Type of Document:                                                                      Country it will be used in:  
 
                 Apostille                             Certificate of Authentication                             Notary Verification  
 
Mailing Address:                                                          
 
City:                                                                   State:                                                           Zip:  
 
Daytime Telephone Number:                                                                Email:   
 
Person Picking up Document(s):                                                           Telephone Number:                                  
(other than client)                                                              
 
FORM OF PAYMENT:  
Please make check or money order payable to:  Government of the Virgin Islands   
 
Number of Documents to be Authenticated/Apostille: __   x $ 30.00 per document   = Total $ ________ 
 
                Money Order No. ________________________ Check Number No. ____________________ 
  
Delivery Method: (Please indicate what type of packaging was provided for returned mail) 
 
Self-addressed carrier label; (FedEx, UPS, or DHL)      Self-addressed USPS Express Envelope with Postage 
 
       Self-addressed USPS Postal Priority with Postage         Self –Addressed Stamped Regular Envelope  
   
Self-addressed, First-Class Envelope with Postage (Insured or Delivery Confirmation) 
 
 
 
 
 
 
 
 
 
 
 
RECEIPT OF DOCUMENTS:  
 
I have reviewed the requested document(s) in its entirety and verify that the names and dates contained therein 
are accurate.   
________________________________ 
 
____________________________         ______________ 
Print Name   
 
 
                        Signature                                                 Date