GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF

GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DEVELOPMENT PERMIT APPLICATION FORM L&WD-5 PROOF OF LEGAL INTEREST AFFIDAVIT I being duly sworn depose and say that: Applicant(s)' (or John Doe of Entity Applicant) 1. am/is the (check one) (log Entity/Applicant) ZRecord title owner (fee simple) ElLessee nOther (specify) Of the real property described as Parcel No(s) C EstateLittle St. James Quarter SS Red Hook Quarter Island tittle St. James Island *Applicant(s) is required to provide documentation for legal interest stated above (e.g. deed, lease, etc.) 2. I have the irrevocable approvals, permission, or power of attorney from all other persons with a legal interest in the property to undertake the work proposed in the permit application as more fully set forth in the exhibit (s) attached hereto: Signature Date Signature Date Print Print The foregoing instrument was acknowledged before me this day of 20 by at county (Name ix Name/Titte of Entity) of Notary Public My Commission expires EFTA00593890