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: Applicankar (or John Doe of Entity Applicant) 1. amfis the (check one) (tor Entity/Applicant) ❑✓Record title owner (fee simple) ElLessee nOther (specify) Of the real property described as Parcel No(s)Great St. James Island EstateGreat St. James Quarter Red Hook Quarter Island Great 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 or Name/Title of Entity) of Notary Public My Commission expires EFTA00593891