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.

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)

Certificate of Service [See §502.320]

[49 FR 44369, Nov. 6, 1984, as amended at 79 FR 46715, Aug. 11, 2014]