Affidavit

Affidavit of U.S. Citizenship

OF

(NAME OF SOLE PROPRIETORSHIP)

State of )

) ss.:

County of )

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

1. That I am the sole proprietor of (Name of Sole Proprietorship) (hereinafter called the ``Proprietorship'') a sole proprietorship organized and existing under the laws of the State of ________, with offices at (Business address). [Evidence of continuing U.S. citizenship status for vessel owners should be filed within 45 days of the annual documentation renewal date. Other parties required to provide evidence of U.S. citizenship status must file within 30 after the original affidavit.];

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

3. That the names of the sole proprietor and any officers or other individuals who are authorized to bind the Proprietorship are as follows:¹

Name Title Date and Place of Birth (City/State)

Name Title Date and Place of Birth

Each of said individuals is a Citizen of the United States by virtue of birth in the United States, birth abroad of U.S. citizen parents, by naturalization, or as otherwise authorized by law, except (give name and nationality of all Non-Citizen officers and directors, if any).

4. That 100% of the ownership in the Proprietorship is vested in a Citizen of the United States free from any trust or fiduciary obligation in favor of any person not a Citizen of the United States; that there are no stock books or records equivalent to a corporation; that through no contract or understanding is it so arranged that any of the voting power of the Proprietorship may be exercised, directly or indirectly, in behalf of any person who is not a Citizen of the United States; and that by no means whatsoever, is any interest in the Proprietorship conferred upon or permitted to be exercised by any person 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).

1Offices that are currently vacant should be noted when listing Officers and Directors in the Affidavit.