USVI Public Records

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ELECTIONS SYSTEM OF THE VIRGIN ISLANDS Sunny Isle Shopping Center Christiansted, VI | P.O. Box 1499 Kingshill, VI 00851 (340) 773-1021 9200 Lockhart Garden Shopping St. Thomas, VI | P.O. Box 6038 St. Thomas, VI 00804 (340) 774-3107 Website: www.vivote.gov EMAIL APPLICATION: St. Croix- esviballotstx@vi.gov or St. Thomas-St. John- esviballotstt@vi.gov ABSENTEE BALLOT APPLICATION APPLICATION INFORMATION TYPE OR PRINT ONLY Name: ______________________________________________________________ Sex: Male  Female  (As listed on the voter Registration Card) Last Four Digits of SS Number: _______________ Date of Birth: _____________Place of Birth: Party Affiliation: Democrat Local Physical Address (No. and Street) ___________________________________________________________________________________ (As listed on registration card) Local Mailing Address: ___________________________________________________________________________________ Telephone: ______________/Work _____________/Home _________________/Cellular _____________/Fax Email Address: ____________________________________ MAIL ABSENTEE BALLOT TO: (Complete mailing address where you want ballot to be mailed) METHOD OF PREFERENCE IN RECEIVING APPLICATION OR BALLOT: WALK-IN  MAIL-IN  E-Mail (MILITARY ONLY)  REASON FOR ABSENTEE BALLOT (MARK X ONLY ONE):  a. Member of the Armed Forces and Spouse or dependent  b. A student residing outside the Territory  c. An officer or employee of the Government of the Virgin Islands or Government of the U.S.  d. Unable to appear because of illness or physical disability (permanent or temporary)  e. A patient in a hospital, nursing home or home for the aged  f. Absent from District because of accompanying a spouse, parent or child who would be entitled to apply for the right to vote by Absentee ballot  g. Detained in jail awaiting action by a grand jury or trial, or has been confined in prison after a conviction for an offense other than a felony  h. Any person who has not been out of the election district for more than 90 days prior to the date of the election for which an absentee status is sought  i. Religious grounds. I REQUEST AN ABSENTEE BALLOT FOR THE FOLLOWING ELECTION(S):  PRIMARY  GENERAL  SPECIAL  ALL Elections conducted in the calendar year __________________________________________ ______________ SIGNATURE OF VOTER or Voter Representative DATE I swear or affirm to the self-administered oath, under penalty of perjury that: A. I am a United States Citizen, eligible to vote in the United States Virgin Islands. B. I have not been convicted of a felon or other disqualifying offense or been adjudicated mentally incompetent, or if so my voting rights have been reinstated. C. I am not requesting a ballot from or voting in any other State, Territory, or Possession or Subdivision of the United States or Foreign country in the coming election(s) D. That I meet all the qualifications of a Virgin Islands elector. E. The information on this form is true and correct. ________________________________________ ____________ SIGNATURE OF ELECTOR/VOTER DATE ____________________________________________________________________________ FOR OFFICIAL USE ONLY -- Registered Voter YES NO Application Rejected   REASON: __________________________________________________________________________________________________________ Ballot Issued   Ballot Returned   CLERK INITIAL: ____________________ SIGN SIGN SIGN