Federal Maritime Commission, Washington, DC.
Informal Docket No. ______
Respondent's Affidavit
I authorize the Small Claims Officer to determine the above-numbered claim in accordance with subpart S ( 46 CFR 502 ) of the Commission's informal procedure for adjudication of small claims subject to discretionary Commission Review.
(Date) _______________________________
(Signed) _______________________________
(Capacity) _______________________________
Verification
State of ______________________, County of ____________________, ss: ____________, being first duly sworn on oath deposes and says that he or she is __________________, (Title or Position) and is the person who signed the foregoing and agrees without qualification to its truth.
_______________________________
Subscribed and sworn to before me, a notary public in and for the State of ________________, County of ________________, this ____________ day of ____________________, 19____.
(Seal)
_______________________________
(Notary Public)
My Commission expires. _______________________________
Certificate of Service [See § 502.320 ]
46 C.F.R. §Exhibit No. 2 to Subpart S [Section502.304(e)] of Part 502