Elections System of the Virgin Islands 
Sunny Isle Shopping Center, Christiansted, St. Croix, V.I. (340) 773-1021 
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 
 
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 
NAME CHANGE 
 
Present Name on registration card:   ___________________________________________________ 
New name to be recorded              :   ___________________________________________________ 
Legal documents proof of change :   ___________________________________________________ 
PARTY AFFILIATION 
 
Present party affiliation: (please check one):    ____Democrat   ____Republican  ____ICM ____  Independent 
New Party Affiliation (please check one)      :    ____Democrat   ____Republican  ____ICM ____  Independent  
 
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 0016/98 
SIGN