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Nominee Helene of Authorization Page} NOMINEE’S FULL NAME: Wilke oe AL THORTAANTION FOR RELEASE OF TSP ORATATHON Carchilly meanlihleouthoriaiog tu rele mficimion dlgiiin. GET sie tienes eit ik 1. 1 Authorize an investigator, special agent, or other duly accredited representative of the authorized any information Local/Federal agency conducting my background investigation or reinvestigation to obtain relating to my activities from individuals, schools, residential management agents, employers, criminal justice agencies, credit bureaus, consumer reporting agencies, collection agencies, retailed business establishments, or other sources of information to include publicly available electronic information. This information muy include but is not limited to my academic, residential, achievement, performance, attendance, disciplinary, employment history, and criminal history record information. | understand that, for some sources of information, a separate release will be needed, and I may be contacted for such a release at a later. date. I Authorize the Social Security Administration (SSA) to verify my Social Security Number (to match my name, Social Security Number, and date of birth with information in SSA records and provide the results of the match) to the United States Office of Personnel Management (OPM) or other Federal agency requesting or conducting my investigation for the purposes outlined above. I authorize SSA to provide explanatory information to OPM, or to thie other Federal agency requesting or conducting my investigation, in the event of a discrepancy. I Authorize custodians of records and other sources of information pertaining to me to release such information upon request of the investigator, special agent, or other duly accredited representative of any Local/Federal agency authorized above regardless of any previous agreement to the contrary. 1 Understand that the information released by records custodians and sources of information is for official use by the Legislature of the Virgin Istands (Government) only for the purposes provided in this Application and that it may be disclosed by the Government only as authorized by law. orize the release of information on my character , background, ability, financial indebtedness and fitness to serve the residents of the United States Virgin Islands by all government Departments and agencies, especially the Bureau of Internal Revenue, Tax Assessor, Department of Justice Division of Paternity and Child Support, Board of Education, Economic Development Authority, U.S, Smal! Business Administration, Small Business Development Center, Police Department, Department of Licensing and Consumer Affairs, if applicable, employers, schools, all law and all other individuals and organizations which may be deemed necessary, to enforcement agencies, authorized Committee on Rules and Judiciary investigators, its staff and any other authorized employees of the Virgin Islands Government a3 may be required. L hereby consent and auth Photocopies of this authorization with my signature are yalid. This authorization is valid for two years from Last Four (4) Digits of SSN li ihe date signed, Nominee Release of Authorization Page| NOMINEE’S FULL NAME: CDeLlara_ <I Ohi AL TIHORTAN ELON POT RELEAST OF INFORSIATION Careluliy coal thik autho toes iii one tiin ahipok vii, Chen alin an lnbe it fie hak 6, CERTIFICATION: rhis document [s to certify ind affirm that all the statements contained herein and ny supporting documents or schedules or other such supporting documents or schedules executed al a Inter date as a part of addendum +o this document are true and correct to the best of my knowledge and are made in good faith. ae a Sinead this 2 day of Nenrwcely 207 6 a » Nominee’s Name (Print Clearly) ominee tue Sworn and Subscribed before me this a) __ day of | 5} 200k. > “).2-Zo2X NOTARY PUBLIC eT. CROIX, U.S. VIRGIN ISLANDS NP - 761-24 Last Four (4) Digits of SSN m7