OFFICE OF THE LIEUTENANT GOVERNOR
OFFICE OF THE LIEUTENANT GOVERNOR NOTARY DIVISION 5049 Kongens Gade • Charlotte Amalie, Virgin Islands 00802 • 340.774.2991 ext 4120 Request Form for Apostille or Certificate of Authentication Person Requesting Service: First Name: Last Name: Date: Names listed on the Document First Name: Last Name: Name of Firm or Organization: Type of Document: Country it will be used in: Apostille Certificate of Authentication Notary Verification Mailing Address: City: State: Zip: Daytime Telephone Number: Email: Person Picking up Document(s): Telephone Number: (other than client) FORM OF PAYMENT: Please make check or money order payable to: Government of the Virgin Islands Number of Documents to be Authenticated/Apostille: ______ x $ 25.00 per document = Total $__________ Money Order No. ____________________________________________ Check No. …
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OFFICE OF THE LIEUTENANT GOVERNOR NOTARY DIVISION 5049 Kongens Gade • Charlotte Amalie, Virgin Islands 00802 • 340.774.2991 ext 4120 Request Form for Apostille or Certificate of Authentication Person Requesting Service: First Name: Last Name: Date: Names listed on the Document First Name: Last Name: Name of Firm or Organization: Type of Document: Country it will be used in: Apostille Certificate of Authentication Notary Verification Mailing Address: City: State: Zip: Daytime Telephone Number: Email: Person Picking up Document(s): Telephone Number: (other than client) FORM OF PAYMENT: Please make check or money order payable to: Government of the Virgin Islands Number of Documents to be Authenticated/Apostille: ______ x $ 25.00 per document = Total $__________ Money Order No. ____________________________________________ Check No. ____________________ Delivery Method: (Please indicate what type of packaging was provided for returned mail) Self-addressed carrier label; (FedEx, UPS, or DHL) Self-addressed USPS Express Envelope with Postage Self-addressed USPS Postal Priority with Postage Self –Addressed Stamped Regular Envelope Self-addressed, First-Class Envelope with Postage (Insured or Delivery Confirmation) RECEIPT OF DOCUMENTS: I have reviewed the requested document(s) in its entirety and verify that the names and dates contained therein are accurate. ________________________________ ____________________________ ______________ Print Name Signature Date SIGN