EFTA Document 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. 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