ELECTION SYSTEM OF THE VIRGIN ISLANDS Sunny Isle Annex Unit 4 Christiansted, VI | P.O. Box 1499 Kingshill, Vi 00851 (340) 773-2021 9200 Lockhart Garden Shopping St. Thomas, VI | P.O. Box 6038 St. Thomas, VI 00804 (340) 774-3107 Website: www.vivote,gov ABSENTEE BALLOT APPLICATION APPUCATION INFORMATION TYPE OR PRINT ONLY Name: Jeffrey E. Epstein Sex: Male @) Female Oo (As listed on the voter Registration Card) Last Four Digits of SS Number: 3348 Date of Birth: (/20/5_2 Place of Birth: New York Party Affiliation: (Select only one) pemocrat(_) Republican Q ICM Q No party(®) Local Physical Address (No. and Street) Little St. James Island St. Thomas, Virgin Islands 00802 {As listed on registration card) Local Mailing Address: 6100 Red Hook Quarter Ste B3 St Thomas, Virgin Islands 00602 Telephone —/Work /Home /Cellular /Fax MAIL ABSENTEE BALLOT TO: (Complete mailing address where you want ballot to be mailed) 575 Lexington Avenue 4th Floor New York, New York 10022 METHOD OF PREFERENCE IN RECEIVING APPLICATION OR BALLOT: WALK-IN___ MAIL-IN____ E-Mail (MILITARY ONLY) _ IN y : a. Member of the Armed Forces and Spouse or dependent b. A student residing outside the Territory c. An officer or employee of the Government of the Virgin Islands or Government of the U.S. d. Unable to appear because of illness or physical disability (permanent or temporary) €. A patient in a hospital, nursing home or home for the aged f. Absent from District because of accompanying a spouse, parent or child who would be entitled to apply for the right to vote by Absentee ballot g. Detained in jail awaiting action by a grand jury or trial, or has been confined in prison after a conviction for an offense other than a felony h. Any person who has not been out of the election district for more than 90 days prior to the date of the election oO for which an absentee status is sought i, Religious grounds EST AN ABSENT! TON(S): PRIMARY GENERAL SPECIAL |_| ALL Elections conducted in the calendar year A. lama United States Citizen, efigib 1 in the United States Virgin Islands. B. | have not been convicted of a felon or other disqualifying offense or been adjudicated mentally incompetent, or if so my voting rights have been reinstated. C. 1am not requesting a ballot from or voting in any other State, Territory, or Possession or Subdivision of the United States or Foreign country in the coming election(s} D. That! meet all the qualifications of a Virgin Islands elector. The informatjoa.gn this form is true and correc! lof / 4. a" DATE R OFFICIAL USE ONLY -- Voter Yl Ballot Issued Ballot Returned Application Rejected REASON: EFTA00304538