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

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