OFFICE OF THE LIEUTENANT GOVERNOR 
    NOTARY DIVISION 
 5049 Kongens Gade, Charlotte Amalie, Virgin Islands 00802 • 340.774-2991  
 
 
   Notary Public Complaint Form 
 
 
 
Revised 8/2023                    
  
 
 
NOTARY PUBLIC COMPLAINT FORM 
                          
Your Name: ________________________    
Telephone: ______________________ 
 
Mailing Address: ____________________                Email: __________________________ 
 
 
NOTARY PUBLIC INFORMATION (please print) 
 
Name of Notary: 
  
Notary Commission Number:   
 
Expiration Date of Commission: 
 
Notary Telephone: ____ -_______-_______ 
 
 
Notary Address: ______________________ 
 
 
Date(s) Alleged Improper Acts Took Place: ___________________________________ 
 
                  PRELIMINARY QUESTIONS (must complete) 
 
1. Is your signature on the subject document(s) a forgery?  
 
     □ YES       □ NO  
2. Did you personally appear before the Notary to sign or acknowledge your □ YES       □ NO 
signature on the subject document(s)? 
3. Did you personally appear before the Notary on the specific date recorded □ YES       □ NO 
in the jurat/notarial certificate? 
4. Did the Notary notarize the document(s) in your presence? 
 
      □ YES       □ NO  
5. Do you personally know the Notary? 
 
 
 
 
      □ YES       □ NO 
 
Important Notice Regarding the Complaint Process 
The Office of the Lieutenant Governor may take disciplinary action against a notary public in 
cases where good cause exists. This Office cannot obtain restitution for losses that may have 
been caused by a notary’s action. This Office cannot assist in filing a claim against the notary’s 
bond and does not have the power to prosecute a notary for criminal violations associated with 
the notary’s official duties. 
 
The Office of the Lieutenant Governor does not represent you as the complainant or the notary 
in the complaint process. Complainants need to present factual evidence, within the 
complainant’s personal knowledge, that the notary engaged in conduct that violates the laws 
and rules governing the conduct of the US Virgin Islands notaries public. This Office does not 
have jurisdiction and cannot take action against a person who is not a commissioned notary 
public.  
 
Thank you for your time, and we appreciate you bringing this situation to our attention. 
  
 
Notary Public Complaint Form
 
                                                                                                                                             Revised 8/2023                    
 
NATURE OF COMPLAINT  
Please do not write on the back of the complaint form. You may attach additional pages if 
necessary.  
Specifically describe the alleged misconduct and attach a copy of the improperly notarized 
document(s).  
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I understand and agree to the imposition of legal penalties for making false statements as set forth 
in 14 V.I.C.§ 843. As the below named complainant, I have personal knowledge of all the facts set 
forth herein and declare that they are true.   
 
Signature: ______________________________________  
Date: 
________________________________ 
 
 
______________________ 
 
  
 
Notary Public Complaint Form
 
                                                                                                                                             Revised 8/2023                    
Must be signed before a notary public. 
 
VERIFICATION OF COMPLAINT  
 
 
State of ______________________) 
County of ____________________) 
 
 
________________________________, the Complainant named in the 
foregoing Complaint being duly sworn, says that the facts and allegations 
contained therein are true, except so far as they are therein stated to be on 
information, and that, so far as they are therein stated to be on information, 
she/he believes them to be true. 
 
 
 
______________________________________________ 
Complainant signature 
 
 
 
Taken, sworn to and subscribed before me this _______day of ___________, 
20____. 
 
 
 
______________________________ 
Notary Public Name 
 
______________________________ 
Notary Public Signature