46 CFR Exhibit No. 2 to Subpart S [§ 502.304(e)] of Part 502: Exhibit No. 2 to Subpart S [§ 502.304(e)] of Part 502—Respondent's Consent Form for Informal Adjudication

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.

(Date)

(Signed)

(Capacity)

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)

My Commission expires.

Certificate of Service [See § 502.320]