46 CFR Appendix A to Subpart A of Part 68: Appendix A to Subpart A of Part 68—Oath for Qualification of Corporation as a Citizen of the United States Under the Act of September 2, 1958 (46 U.S.C. app. 883-1)

Department of Homeland Security, U.S. Coast Guard

Oath for Qualification of Corporation as a Citizen of the United States Under the Act of September 2, 1958 (46 U.S.C. app. 883-1)

Corporation:

Name

Address 1

State where incorporated

Affiant:

Name

Address

Company

Title or capacity

I, the affiant named above, swear that I am legally authorized to make this oath on behalf of the corporation, that a majority of the officers and directors of the above-named corporation are citizens of the United States, as shown by the attached listing incorporated in and made a part of this oath which truly and correctly names all such officers and directors, giving the home address and citizenship of each; that not less than 90 percent of the employees of the corporation are residents of the United States; that the corporation is engaged primarily in a manufacturing or mineral industry in the United States or in a territory, district or possession thereof; that the aggregate book value of the vessels owned by the corporation does not exceed 10 percent of the aggregate book value of the assets of the corporation; and that the corporation purchases or produces in the United States, its territories or possessions not less than 75 percent of the raw materials used or sold in its operation. 2

The above named corporation fails to qualify as a citizen within the meaning of § 67.39(c) of this chapter by reason of: 3

______Non-citizen President

______Non-citizen Chairman of Board

______Failure to meet quorum requirements

______Failure to meet stock ownership requirements

Signature

Subscribed and sworn to before me on the day and year shown

(Notary Public)

Date