EFTA01733947

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 Pin Print Name of Vote/ 2'2 t I Ni• I 1/4 • 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; ss knii-s within shetnrsie bleeds; that I was born JC:011 ; 3)0, 1053 at Kieuo (Pafratnni)k lc 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 (Date ciBection) instructions forwarded to me with the within ballot. So help me (Signature) (Seal. If any) Name 'that I have read carefully the erein enclosed, and sealed 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 ♦ • II Ma No ■ Us UNITED STATES VIRGIN ISLANDS ISLAS WRGENES DE LOS ESTADOS GENERAL ELECTION / ELECC/ONES NOVEMBER 8. 2016 / 8 DE NOVIEMBRE OFFICIAL BALLOT / BOLETA ST. THOMAS 1ST. JOHN - SAN TOMAS STTISALAUSCOlca. O C) IIIEIRUCTIONS et tCWF,tp_t•t CUM P AO .47 f irnAniftlilli MP S"' Az_ _ :ram /Ratty E. Plabatt 0••••• I Oareows 2 bib, maim yost You Raid InetruckaS wry wil• on both sides Tim oray rosy to not yin Slot bflalr WOW IDS WSW Is lo to =v4~4 In ass Nehru:I Ms . Mobp(s) M ou, ato AO Ohm mantis) an yafts MM. do. your veMs)*4 rot CO 0311.100. Nita TO MO be person miming bike banana sate Vr mons on Pr Ire prontlet aid COMPLETELY MS, the oval to en blot that men Epos masa/mistake or a Wry roork, mil for • now bold horn tM pc* imams INSTRUCCIO NE S Las Ms Instrucc/Oon coo :Sento nos do manw sir manakin. 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Earainv IIINNIOSIPOI litliPeret ci 13 SOMA. /Fog* 14 MOM, M. Maw iniapsedwe napsivel ter • 15 Dwayne DaGniff msomorignmentarn 4.16 Albert F. Rictsoson idepenzerd /bawds,' • 11Kowla A. RodrIgua Macaw Omoom .11 Werth A. Btvsa DOPC011 /00.3•7114 19 Paiskli Matson Sprat Dwane 'Orono Eons o 2Mts-10 &oleo o Imo mom o Yfrilschl Ewes 0 o Vac= Erma o 15111arin EFTA_R1_00010854 EFTA01733949 r ■ ■ ■ ■ ■ ■ ■ O 0 • affi as 0 it I to ■ 0 -1 D o ii 0 li 0 • I I , II 0 ow I 0 • 1 a 1 % • 11 il it - 0 • IIr I i 0 •• il ir L5 9980l000-Ld-Vid3 • ■ ■ ■ N a a a a EFTA01733950