Cancellation of Former Registration
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 CANCELLATION OF FORMER REGISTRATION Date Registered: ________________ Name _____________________________________ I am now registered as an Elector in _____________________, Virgin Islands and hereby authorize the cancellation of my former registration in____________________________ (City or Town) Former Name: ____________________________ (If different from present legal name) Former Address: _____________________________________ Date Of Birth: _______________________ Place Of Birth: ____________________ __________________________ Signature of Elector OFFICIAL USE ONLY Verified by: ____________________________________ Date:_________________ ______________________________________________________________________ Election Officials ELECTION SYSTEMS OF THE VIRGIN ISLANDS FORM 0014/98 SIGN
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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 CANCELLATION OF FORMER REGISTRATION Date Registered: ________________ Name _____________________________________ I am now registered as an Elector in _____________________, Virgin Islands and hereby authorize the cancellation of my former registration in____________________________ (City or Town) Former Name: ____________________________ (If different from present legal name) Former Address: _____________________________________ Date Of Birth: _______________________ Place Of Birth: ____________________ __________________________ Signature of Elector OFFICIAL USE ONLY Verified by: ____________________________________ Date:_________________ ______________________________________________________________________ Election Officials ELECTION SYSTEMS OF THE VIRGIN ISLANDS FORM 0014/98 SIGN