Notary Public Affidavit Form  |  Revised 4/2026 
 
 
 
GOVERNMENT OF THE VIRGIN ISLANDS  
OFFICE OF THE LIEUTENANT GOVERNOR 
NOTARIES PUBLIC DIVISION 
 
 
CERTIFICATION 
IMPORTANT: This certification must be completed by another Notary Public in support of the 
applicant's Notary Bond Application. 
 
TERRITORY OF THE VIRGIN ISLANDS 
) 
 
) SS. 
JUDICIAL DISTRICT OF ______________________________ 
) 
 
I, ____________________________________________________, a Notary Public in and for the 
Territory of the Virgin Islands, Judicial District of ______________________________________, 
do hereby certify that ___________________________________________________, as Principal, 
is personally known to me to be the same person whose name is subscribed to the foregoing Notary Bond; 
that the principal appeared before me this day in person and acknowledged that they signed, sealed, and 
delivered the instrument as their free and voluntary act for the uses and purposes set forth therein. 
 
EXECUTION AND NOTARIAL SEAL 
 
Given under my hand and seal of office this ______ day of ____________________, 20___________. 
 
  
Signature of Notary Public _____________________________ 
  
Printed Name _______________________________________ 
Notary Public Commission Number______________________   
 
Commission Expiration Date___________________________