OFFICE OF THE LIEUTENANT GOVERNOR
OFFICE OF THE LIEUTENANT GOVERNOR NOTARY DIVISION 5049 Kongens Gade, Charlotte Amalie, Virgin Islands 00802 • 340.774-2991 Notary Public Complaint Form Revised 8/2023 NOTARY PUBLIC COMPLAINT FORM Your Name: ________________________ Telephone: ______________________ Mailing Address: ____________________ Email: __________________________ NOTARY PUBLIC INFORMATION (please print) Name of Notary: Notary Commission Number: Expiration Date of Commission: Notary Telephone: ____ -_______-_______ Notary Address: ______________________ Date(s) Alleged Improper Acts Took Place: ___________________________________ PRELIMINARY QUESTIONS (must complete) 1. Is your signature on the subject document(s) a forgery? □ YES □ NO 2. Did you personally appear before the Notary to sign or acknowledge your □ YES □ NO signature on the subject document(s)? 3. Did you personally appear before the Notary on the specific date recorded □ YES □ NO in the jurat/notarial certificate? 4. Did the Notary notarize the document(s) in your presence? □ YES □ NO 5. Do you personally know the Notary? …
Download the original document · Plain text (TXT) · Browse the archive · How this archive works
Original source: https://web.archive.org/web/20230922082139id_/https://ltg.gov.vi/wp-content/uploads/2023/08/Notary-Offical-Complaint-Form.pdf
SHA-256 ec40b8ada129fd25acc4c5d79b30840f27418fad7e74626ce5fbcccbc10c43ed
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-ec40b8ada129
Document text
OFFICE OF THE LIEUTENANT GOVERNOR NOTARY DIVISION 5049 Kongens Gade, Charlotte Amalie, Virgin Islands 00802 • 340.774-2991 Notary Public Complaint Form Revised 8/2023 NOTARY PUBLIC COMPLAINT FORM Your Name: ________________________ Telephone: ______________________ Mailing Address: ____________________ Email: __________________________ NOTARY PUBLIC INFORMATION (please print) Name of Notary: Notary Commission Number: Expiration Date of Commission: Notary Telephone: ____ -_______-_______ Notary Address: ______________________ Date(s) Alleged Improper Acts Took Place: ___________________________________ PRELIMINARY QUESTIONS (must complete) 1. Is your signature on the subject document(s) a forgery? □ YES □ NO 2. Did you personally appear before the Notary to sign or acknowledge your □ YES □ NO signature on the subject document(s)? 3. Did you personally appear before the Notary on the specific date recorded □ YES □ NO in the jurat/notarial certificate? 4. Did the Notary notarize the document(s) in your presence? □ YES □ NO 5. Do you personally know the Notary? □ YES □ NO Important Notice Regarding the Complaint Process The Office of the Lieutenant Governor may take disciplinary action against a notary public in cases where good cause exists. This Office cannot obtain restitution for losses that may have been caused by a notary’s action. This Office cannot assist in filing a claim against the notary’s bond and does not have the power to prosecute a notary for criminal violations associated with the notary’s official duties. The Office of the Lieutenant Governor does not represent you as the complainant or the notary in the complaint process. Complainants need to present factual evidence, within the complainant’s personal knowledge, that the notary engaged in conduct that violates the laws and rules governing the conduct of the US Virgin Islands notaries public. This Office does not have jurisdiction and cannot take action against a person who is not a commissioned notary public. Thank you for your time, and we appreciate you bringing this situation to our attention. Notary Public Complaint Form Revised 8/2023 NATURE OF COMPLAINT Please do not write on the back of the complaint form. You may attach additional pages if necessary. Specifically describe the alleged misconduct and attach a copy of the improperly notarized document(s). _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ I understand and agree to the imposition of legal penalties for making false statements as set forth in 14 V.I.C.§ 843. As the below named complainant, I have personal knowledge of all the facts set forth herein and declare that they are true. Signature: ______________________________________ Date: ________________________________ ______________________ Notary Public Complaint Form Revised 8/2023 Must be signed before a notary public. VERIFICATION OF COMPLAINT State of ______________________) County of ____________________) ________________________________, the Complainant named in the foregoing Complaint being duly sworn, says that the facts and allegations contained therein are true, except so far as they are therein stated to be on information, and that, so far as they are therein stated to be on information, she/he believes them to be true. ______________________________________________ Complainant signature Taken, sworn to and subscribed before me this _______day of ___________, 20____. ______________________________ Notary Public Name ______________________________ Notary Public Signature