Fillable 2024 General Election Absentee Application 1
ELECTIONS SYSTEM OF THE VIRGIN ISLANDS Sunny Isle Shopping Center Unit 26 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: esviballotsttj@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: (Select only one) Democrat ___ Republican ___ ICM ___ No Party ___ Local Physical Address (No. …
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ELECTIONS SYSTEM OF THE VIRGIN ISLANDS Sunny Isle Shopping Center Unit 26 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: esviballotsttj@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: (Select only one) Democrat ___ Republican ___ ICM ___ No Party ___ Local Physical Address (No. and Street) ___________________________________________________________________________________ (As listed on registration card) Local Mailing Address: ___________________________________________________________________________________ Telephone: ______________/Work _____________/Home _________________/Cellular _____________/Fax Email Address: ________________________________ I REQUEST AN ABSENTEE BALLOT FOR THE FOLLOWING ELECTION(S): ___ PRIMARY ___ GENERAL ___ SPECIAL ___ ALL Elections conducted in the calendar year METHOD OF PREFERENCE IN RECEIVING APPLICATION OR BALLOT: WALK-IN____ MAIL-IN____ E-MAIL*____ MAIL ABSENTEE BALLOT TO: (Complete mailing address where you want ballot to be mailed) ____________________________________________________________________________________ ____________________________________________________________________________________ __________________________________ _______________ 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 *Please Note: To receive an absentee ballot via email, you must waive your right to a secret ballot. FOR OFFICIAL USE ONLY -- Registered Voter YES NO Application Rejected ____ ____ REASON: ______________________________ Ballot Returned ____ ____ Application Rejected ____ ____ CLERK INITIAL: ____________________ SIGN SIGN