RELEASE AUTHORIZATION 
Please check ONE of these boxes: 
       I am an Entity. _______________________________________________ /________________________ 
    (Print Name of Entity) 
 
 
 
 
EIN 
       I am an Individual holding five percent (5%) or more ownership interest in the entity. 
___________________________________________/_________________________ 
 (Print Name of Individual)   
 
 
 
SSN 
As the above-referenced individual or duly authorized representative of the entity, I hereby authorize the Virgin 
Islands Economic Development Authority (“VIEDA”) to conduct a full background investigation. 
I hereby authorize VIEDA or its designees to submit this Release Authorization (“Release”) to all courts, probation 
offices, Selective Service Boards, employers, credit agencies, educational institutions, banks, financial and other 
institutions, and all governmental agencies or other entities -- federal, state and local, both foreign and domestic -- 
as may be required by VIEDA to perform background investigations for the purpose of processing applications for 
tax incentives administered through the Virgin Islands Economic Development Commission.   
This Release shall supersede and countermand any prior authorization(s) to the contrary and shall remain in effect 
until such time as withdrawn in writing.  
___________________________  
_____________ 
________________________ 
Signature 
Print Name 
Title 
___________________________ 
________________________ 
Date of Birth 
Place of Birth 
Telephone Number 
__________________________    
__________________________________________________ 
Email address 
Current Physical Address (including City, State, Zip Code) 
ACKNOWLEDGMENT 
STATE OF ____________________________________________________ 
) 
) 
COUNTY OR DISTRICT OF ________________________________________ 
) SS: 
On this                        day of 
 ______   , 20___, before me the undersigned officer, personally appeared 
____________________________, known to me or satisfactorily proven to be the person whose name is 
subscribed to the within instrument, and acknowledged that he/she is authorized to execute same for the 
purposes therein contained. 
IN WITNESS WHEREOF, I hereunto set my hand and official seal. 
________________________ 
Notary Public 
Commission Expires: 
A photocopy, electronic, or similar copy of this Release shall be considered as effective and valid as the original. 
(Rev. 01/2026)