Affidavit

AFFIDAVIT OF U.S. CITIZENSHIP

OF

(NAME OF PARTNERSHIP)

State of )

) ss.:

County of )

I, (Name), of (Physical residence address, city, and state), being duly sworn, depose and say:

1. That I am a partner in (Name of Partnership), a partnership organized and existing under the laws of the State of ______ with offices at (Business address) (hereinafter called the “Partnership”), in evidence of which formation a true copy of the Partnership Agreement dated ( Date ) is filed herewith (or has previously been filed with the Maritime Administration). [Evidence of continuing U.S. citizenship status, including amendments to said Partnership Agreement, should be filed at least 45 days prior to the annual documentation renewal date for vessel owners. Other parties required to provide evidence of U.S. citizenship status must file within 30 days after the annual meeting of the Partnership or annually, within 30 days after the original affidavit if there has been no meeting of the Partnership prior to that time.];

2. That I am authorized by and in behalf of the Partnership to execute and deliver this Affidavit of U.S. Citizenship;

3. That the partnership information upon which (Name of Partnership) relies to establish that 100% of the ownership and control in the Partnership is vested in Citizens of the United States, is as follows: ________________________________________________________________________

Name of Partner Title Date & Place of Birth Partnership Interest

Name General ( %)

( %)

Total Partnership Interest 100%

______________________________ __________________________________________

and that each of said individual partners is a Citizen of the United States by virtue of birth in the United States, birth abroad of U.S. citizen parents, or as otherwise authorized by law.

Note: Applicable citizenship information for Partners that are not individual persons may be included in the present affidavit or attached in a separate affidavit.

4. That 100% of the interest in the Partnership, as established by the information herein before set forth, is owned by Citizens of the United States; that the title to 100% of the shares of the Partnership is vested in Citizens of the United States free from any trust or fiduciary obligation in favor of any person not a Citizen of the United States; that 100% of the voting power of the Partnership is vested in Citizens of the United States; that through no contract or understanding is it so arranged that any of the voting power of the Partnership may be exercised, directly or indirectly, in behalf of any person(s) who is not a Citizen of the United States; and that by no means whatsoever, is any interest in or control of any interest in the Partnership conferred upon or permitted to be exercised by any person(s) who is not a Citizen of the United States; and

5. That the affiant has submitted all of the necessary documentation required under 46 C.F.R. § 356.13 in connection with this Affidavit of U.S. Citizenship for the vessels herein identified;

6. That affiant has carefully examined this affidavit and asserts that all of the statements and representations contained therein are true to the best of his knowledge, information, and belief.

_______________________________

(Name and title of affiant)

.

(Signature of affiant) Date

Penalty for False Statement: A fine or imprisonment, or both, are provided for violation of the proscriptions contained in 18 U.S.C. 1001 (see also, 18 U.S.C. 286, 287 and 46 App. U.S.C. §12122).

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