Election 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 00804



CHANGE OF VOTER REGISTRATION CARD / STATUS .



TERRITORY OF THE VIRGIN ISLANDS)

DISTRICT OF )



I, HEREBY REQUEST A CHANGE OF MY VOTER

REGISTRATION CARD / STATUS.



TYPE OF CHANGE (Please check below)

Change of name

Change of Party / Membership Request

Change of Address Physical or Mailing

Other/ Phone #s & e-mail



NAME CHANGE



Present Name on registration card:

New name to be recorded:

Lega! documents proof of change:



PARTY AFFILIATION

Present party affiliation:(please check one): ___ Democrat Republican ___ ICM independent

Other

New Party affiliation (please check one): ___-s Democrat Republican ___— ICM Independent___

Other

ADDRESS

Present Address:

Previous Address:

Present Mailing Address:

Previous Mailing Address:

Date Signature of Elector

OFFICIAL USE ONLY

Verified by: Date:



Election Officials



SUBSCRIBED AND SWORN to before me on this day of

20 .



Notary Public



ELECTION SYSTEMS OF THE VIRGIN ISLANDS FORM 0015/98