EFTA01733947.pdf

AFFIDAVIT OF PERSON ASSISTING VOTER FORM: If you have been asked to assist a voter for whatever number of reasons, please be sure to submit this signed Affidavit with the completed ballot. Elector/Voter: Name I hereby swear or affirm that I assisted the above named elector in the preparation of the above affidavit and/or in the preparation of the ballot since the voter was unable because of physical disability, or inability to read English or Spanish language, to mark the ballot in an informed manner or properly execute the aforementioned affidavit. I further swear or affirm that I marked the ballot as directed by the elector and shall hereafter give no information regarding same. I did not assist more than one voter during this election. Steatuse of Assistant ant WAIVER OF RIGHT TO A SECRET BALLOT FORM ATTACH TO FAX OR EMAIL VOTING FORMS Don't forget to attach a scanned or faxed copy of your ballot, your self-administered Oath form and the below Waiver of Right to a Secret Ballot as follows: "i understand that a -suit of my transmittal by Facsimile or e- mail of my marked Absente tallot, I hereby warily waive My Right to a Secret Ballot." 7/ Signature of ifOlgg Print Name of Vote/ Pin 2'2 t I Ni• I 14/ • Saha Seturhy Number of voter Oats Signed Rev 6/3/2014 EFTA_R1_00010852 EFTA01733947  All persons voting by absentee ballot shall subscribe to and take the following oath: Territory of Virgin Islands District of C 1Ti -CtinCtS I ipt. : •i .do solemnly swear (or affirm) that I am the identical person whom I represent myself to be; chat, I have been a resident of theVirgin Islands for I months, and of the Election District of Si - .1"\flinffel iff :CST ---\74::-\fi for 1-1, yen, mondts; that I now reside at L-1 ++(C • :SCATilec; ssknii-s within shetnrsie bleeds; that I was born JC:011 ; 3)0, 1053 at Kieuo (Pafratnni) k l c Pt (Place of birth) (If naturalized, give place and date of naturalization) ; that (I am a legal voter) (I am qualifying-as-a legal-voter)-in said election district that I am unable to vote in person at the election to be held in said district on '. 'flilrAf( 2:1C, I 'that I have read carefully the (Date ciBection) instructions forwarded to me with erein enclosed, and sealed the within ballot. So help me (Signature) (Seal. If any) Name Official Title Residence U-i-He YarC, AS TI AFFIDAVIT OF PERSON ASSISTING VOTER: I hereby swear or affirm that I assisted the above-named elector in the preparation of the above affidavit and / or in the preparation of the ballot since the voter was unable because of physical disability, or inability to read English or Spanish language, to mark the ballot in an informed manner or properly execute the above affidavit I further swear or affirm that I marked the ballot as directed by the elector and shall hereafter give no information regarding same. I did not assist more than one voter during this election. Signature of Assistant Date EFTA_R1_00010853 EFTA01733948 r ♦ • UNITED STATES VIRGIN ISLANDS ISLAS WRGENES DE LOS ESTADOS UNIDOS II GENERAL ELECTION / ELECC/ONES GENERAL NOVEMBER 8. 2016 / 8 DE NOVIEMBRE 2016 OFFICIAL BALLOT / BOLETA OFICIAL ST. THOMAS 1ST. JOHN - SAN TOMAS /SAN JOHN STTISALAUSCOlca. et tCWF,tp_t•t CUM P AO . ..FIE CO ME .01CM • 1,1%, Ma .47 f irnAniftlilli &VIM: atter •owne. ra. No • fel:• Or ■ Us O Az_ MP _ :ram S"' • tant rola* • SA-VAmi• StorioCre nil.* 7 C) /Ratty E. Plabatt 2 Jams Millstroung 0••••• IOareows Ormanettimerma IIIEIRUCTIONS Ian" 4.3 TiMPois A. Roach Raid InetruckaS sermonsentammemme bib, maim yost You wry wil• on both sides St maim ay 'DAM 4 Alma Francis tempt Tim oray rosy to not yin Slot Iler.W••• acos•c•c•• lepondon Ardironanibe bflalr WOW IDS WSW Is &tax.: /0 lo =v4~4 In ass Nehru:I 1115 Justin Manion. Sr. to Ms . yafts Mobp(s) Mato AO Ohm Man A. Smith Dna:•ra I Oesants mantis) an ou, MM. do. 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