ELECTIONS SYSTEM OF THE VIRGIN ISLANDS 
Sunny Isle Shopping Center Christiansted, VI | P.O. Box 1499 Kingshill, VI 00851 (340) 773-1021 
9200 Lockhart Garden Shopping St. Thomas, VI | P.O. Box 6038 St. Thomas, VI  00804 (340) 774-3107 
Website:  www.vivote.gov  
EMAIL APPLICATION: St. Croix- esviballotstx@vi.gov or St. Thomas-St. John- esviballotstt@vi.gov 
       ABSENTEE BALLOT APPLICATION 
APPLICATION INFORMATION 
TYPE OR PRINT ONLY 
Name: ______________________________________________________________ Sex:  Male     Female   
    (As listed on the voter Registration Card) 
Last Four Digits of SS Number: _______________ Date of Birth: _____________Place of Birth: 
Party Affiliation: Democrat  
Local Physical Address (No. and Street) 
___________________________________________________________________________________ 
    (As listed on registration card) 
Local Mailing Address: 
___________________________________________________________________________________ 
Telephone: ______________/Work   _____________/Home   _________________/Cellular _____________/Fax 
Email Address: ____________________________________ 
MAIL ABSENTEE BALLOT TO: (Complete mailing address where you want ballot to be mailed) 
METHOD OF PREFERENCE IN RECEIVING APPLICATION OR BALLOT: WALK-IN     MAIL-IN     E-Mail (MILITARY ONLY)  
       REASON FOR ABSENTEE BALLOT (MARK X ONLY ONE): 
  a.  Member of the Armed Forces and Spouse or dependent 
  b.  A student residing outside the Territory 
  c.  An officer or employee of the Government of the Virgin Islands or Government of the U.S. 
  d.  Unable to appear because of illness or physical disability (permanent or temporary) 
  e.  A patient in a hospital, nursing home or home for the aged 
  f.   Absent from District because of accompanying a spouse, parent or child who would be entitled to apply for the 
      right to vote by Absentee ballot 
  g.  Detained in jail awaiting action by a grand jury or trial, or has been confined in prison after a conviction for an 
      offense other than a felony 
  h.  Any person who has not been out of the election district for more than 90 days prior to the date of the election 
      for which an absentee status is sought 
  i.   Religious grounds.
I REQUEST AN ABSENTEE BALLOT FOR THE FOLLOWING ELECTION(S): 
 PRIMARY   
   GENERAL        SPECIAL       ALL Elections conducted in the calendar year 
__________________________________________ 
______________ 
   SIGNATURE OF VOTER or Voter Representative 
          DATE 
I swear or affirm to the self-administered oath, under penalty of perjury that: 
A.
I am a United States Citizen, eligible to vote in the United States Virgin Islands.
B.
I have not been convicted of a felon or other disqualifying offense or been adjudicated mentally incompetent, or if so my
voting rights have been reinstated.
C.
I am not requesting a ballot from or voting in any other State, Territory, or Possession or Subdivision of the United States
or Foreign country in the coming election(s)
D.
That I meet all the qualifications of a Virgin Islands elector.
E.
The information on this form is true and correct.
________________________________________ 
 
 
 
____________ 
       SIGNATURE OF ELECTOR/VOTER 
 
 
                    
         DATE 
____________________________________________________________________________ 
FOR OFFICIAL USE ONLY  --  Registered Voter                 YES           NO 
Application Rejected                                  
REASON: __________________________________________________________________________________________________________          
Ballot Issued             
                       
Ballot Returned                                                  CLERK INITIAL: ____________________ 
SIGN
SIGN
SIGN