Affidavit

OMB No. 2133-0530
Expiration: January 31, 2020
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for
failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of
information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2133-0530. Public
reporting for this collection of information is estimated to be approximately 5.90 hour per response, including the time for reviewing
instructions, completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden to: Information Collection Clearance Officer, Maritime Administration, MAR-390, 1200 New Jersey Avenue, SE, Washington, DC
20590.

AFFIDAVIT OF U.S. CITIZENSHIP
OF
(NAME OF LIMITED LIABILITY PARTNERSHIP)
State of
County of

)
) ss.:
)

I, (Name), of (Physical residence address, city, and state), being duly sworn, depose and say:
1. That I am a general partner in (Name of Limited Liability Partnership), a limited
liability partnership organized and existing under the laws of the State of ______ with offices at
(Business address) (hereinafter called the “LLP”), in evidence of which formation a true copy of
the Articles of the Limited Liability Partnership 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 Articles of Limited Liability Partnership,
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 LLP to execute and deliver this Affidavit
of U.S. Citizenship;
3. That the LLP is a Limited Liability Partnership with within the State of

;

4.That the partnership information upon which (Name of LLP) relies to establish that
100% of the ownership and control 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, except
(give name and nationality for any above identified partners who are not U.S. Citizens).

Note: Applicable citizenship information for Partners that are not individual persons may be
included in the present affidavit or attached in a separate affidavit.
5. That 100% of the interest in the LLP, as established by the information herein before
set forth, is owned and controlled by Citizens of the United States; that the title to 100% of the
shares of the LLP 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 such proportion of the
voting power of the LLP 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 LLP 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 LLP conferred
upon or permitted to be exercised by any person(s) who is not a Citizen of the United States; and
6. 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.
7. 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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