Code of Federal Regulations Title 46. Shipping 46 CFR Pt. 502, Subpt. S, Exh. 2 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]