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 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 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).

2