DHS Application Form
GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES Department of Human Services Re ea ——— Office of the Commissioner Elder, Dependent Adult, and Disabled Person Disaster Registry Title 34 Virgin Islands Code, chapter 16 subchapter Ii established the Elder, Dependent Adult, and Disabled Persons Disaster Registry. Title 34 Virgin Islands Code, chapter 16, subchapter Il, section 521 states, “The Department of Human Services shall issue forms to the Bureau of Motor Vehicles and the Virgin Islands Elections System to be used to collect the information for the registry. Last Name: First Name: Primary Telephone: Secondary Telephone: Physical Address: City/Island: Zip Code: Email Address: Directions to the Address: (Include landmarks, color or home and all other recognizable features) EMERGENCY CONTACT INFORMATION Last Name: First Name: Primary Telephone: Secondary Telephone: Email Address: Signature of Registrant: _—_—_—_ ee a 4 3011 Golden Rock « Christiansted, St. Croix, Virgin Islands 00820 « (340) 718-2980 ph » (340) 718-4044 fax Knud Hansen Complex Bldg. …
Download the original document · Plain text (TXT) · Browse the archive · How this archive works
Original source: https://vivote.gov/sites/default/files/forms/DHS%20Application%20Form.pdf
SHA-256 c47f036b99003bb6320263e877a82fc74057d0cbe62f8d756559c074e02b333c
Re-using this document
A public record of the Government of the Virgin Islands, published by the agency itself. No copyright is asserted on it and 17 U.S.C. § 105 does not reach territorial government, so it publishes as a territorial public record.
Our description, tagging, arrangement, extracted text and machine transcripts are released under CC0 1.0. We assert nothing about the document itself.
Archive identifier LF-c47f036b9900
Document text
GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES Department of Human Services Re ea ——— Office of the Commissioner Elder, Dependent Adult, and Disabled Person Disaster Registry Title 34 Virgin Islands Code, chapter 16 subchapter Ii established the Elder, Dependent Adult, and Disabled Persons Disaster Registry. Title 34 Virgin Islands Code, chapter 16, subchapter Il, section 521 states, “The Department of Human Services shall issue forms to the Bureau of Motor Vehicles and the Virgin Islands Elections System to be used to collect the information for the registry. Last Name: First Name: Primary Telephone: Secondary Telephone: Physical Address: City/Island: Zip Code: Email Address: Directions to the Address: (Include landmarks, color or home and all other recognizable features) EMERGENCY CONTACT INFORMATION Last Name: First Name: Primary Telephone: Secondary Telephone: Email Address: Signature of Registrant: _—_—_—_ ee a 4 3011 Golden Rock « Christiansted, St. Croix, Virgin Islands 00820 « (340) 718-2980 ph » (340) 718-4044 fax Knud Hansen Complex Bldg. A * 1303 Hospital Ground « St. Thomas, Virgin islands 00802 * (340) 774-0930 ph « (340) 774-3466 fax