Elections 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 00801 
CANCELLATION OF FORMER REGISTRATION 
Date Registered: ________________ 
Name _____________________________________ 
I am now registered as an Elector in _____________________, Virgin Islands and 
hereby 
authorize the cancellation of my former registration in____________________________ 
(City or Town) 
Former Name: ____________________________ 
(If different from present legal name) 
Former Address: _____________________________________ 
Date Of Birth: _______________________ 
Place Of Birth: ____________________ 
__________________________ 
Signature of Elector 
OFFICIAL USE ONLY
Verified by: ____________________________________ 
Date:_________________ 
______________________________________________________________________ 
Election Officials 
ELECTION SYSTEMS OF THE VIRGIN ISLANDS FORM 0014/98
SIGN