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