Notary Public Affidavit Form  |  Revised 4/2026 
 
 
 
GOVERNMENT OF THE VIRGIN ISLANDS  
OFFICE OF THE LIEUTENANT GOVERNOR 
NOTARIES PUBLIC DIVISION 
 
 
AFFIDAVIT 
TERRITORY OF THE VIRGIN ISLANDS 
) 
 
) SS. 
JUDICIAL DISTRICT OF ______________________________ ) 
I, ____________________________________________, residing at _____________________________ 
______________________________________________________________________, being duly sworn 
(or affirmed), depose and state: 
1.  I am a citizen of the United States and a resident of the Virgin Islands. 
2.  I have resided in the Virgin Islands for the past ____________ years. 
3.  I am ______ years of age. 
4.  Please check one: 
☐  I am a graduate of an accredited high school; OR 
☐  I have passed the High School Equivalency Test (GED). 
5.  I have never been convicted of any crime, either within or outside the Virgin Islands. 
6.  I will continue to reside in the Virgin Islands during the term of my commission. 
This affidavit is submitted in support of my application for a Notary Public Commission in the Virgin 
Islands. 
 
 
 
Affiant's Signature 
 
NOTARIAL CERTIFICATE 
 
Signed and sworn to (or affirmed) before me on this ______ day of ____________________, 20____, 
by ____________________________________________, on the island of St.  
__________________________, U.S. Virgin Islands. 
  
Signature of Notary Public _____________________________ 
 Printed Name _______________________________________ 
Notary Public Commission Number______________________   
Commission Expiration Date____________________________