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 
AFFIDAVIT 
Pursuant Title 18 section 100(d) of the Election Laws of the Virgin Islands 
TERRITORY OF THE VIRGIN ISLANDS  
District of St.______________________ 
I ______________________________________ DO HEREBY SWEAR AND AFFIRM: 
That I am a registered voter in the district of St. ____________________; 
That I reside at_________________________________ in the district of ___________; 
That I am personally acquainted with _____________________________ who resides  
at_____________________________________in the district of St. ________________; 
That I know that the applicant has alleged inability to sign his name, and it is my belief 
that the statement or statements made by the applicant under oath or affirmation in 
applying for registration are true and correct 
__________________________ 
Signature of Affiant 
SUBSCRIBED 
AND 
SWORN 
to 
before 
me 
on 
this 
___________day 
of________________ 20____ .  
_______________________ 
Notary Public 
ELECTION SYSTEMS OF THE VIRGIN ISLANDS FORM 0013/98