Examination of Records Form 2
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 EXAMINATION & COPY OF RECORDS TERRITORY OF THE VIRGIN ISLANDS District of St. _____________________ Name: _______________________________ Date: ______________________ Mailing or Physical Address: ______________ Telephone#: ________________ ______________________________________ I am a register voter: Yes No Number of Copies Requested:________ Name of Documents to be examined: ________________________________________ ______________________________________________________________________ Purpose of examination of document(s)______________________________________ Fee due to the Election System of the Virgin Islands: $___________ I understand that I must abide by the procedures that govern the examination and copying of records, no records are to be removed from the viewing area, and no records are to be writte …
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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 EXAMINATION & COPY OF RECORDS TERRITORY OF THE VIRGIN ISLANDS District of St. _____________________ Name: _______________________________ Date: ______________________ Mailing or Physical Address: ______________ Telephone#: ________________ ______________________________________ I am a register voter: Yes No Number of Copies Requested:________ Name of Documents to be examined: ________________________________________ ______________________________________________________________________ Purpose of examination of document(s)______________________________________ Fee due to the Election System of the Virgin Islands: $___________ I understand that I must abide by the procedures that govern the examination and copying of records, no records are to be removed from the viewing area, and no records are to be written on our altered in any way. If this office should all of sudden need to refer to records, which are being viewed by a person, then the records are immediately returned upon request. I, the undersigned, declare under perjury that the information furnished herein is correct and complete and that I will only utilize the information for the purpose outline in the request, nor will I disposed of it in an unauthorized manner as determined by the Election System of the Virgin Islands. _________________________ Signature of Requestor Reviewed by: _____________________________________________________________________ ELECTION OFFICIAL ELECTIONS SYSTEM OF THE VIRGIN ISLANDS FORM Revised 0008/2010 SIGN