OFFICE OF THE LIEUTENANT GOVERNOR 
NOTARY DIVSION 
     1105 King Street • Christiansted, Virgin Islands 00820 • 340.773.6449 • Fax 340.719.2355 
  5049 Kongens Gade • Charlotte Amalie, Virgin Islands 00802 • 340.776-8505 • Fax 340.779.7825 
Request Form for Apostille or Certificate of Authentication 
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: 
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 $ 25.00 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