Code of Federal Regulations Title 46. Shipping 46 CFR Pt. 68, Subpt. A, App. A 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

 Show principal place of business of corporation.

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

 Attach the required list of the names of all officers and directors of the corporation, giving the home address and citizenship of each.

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

 Check appropriate line or lines.

______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