Sample Draft of Declaration

I, ______________________________ of ____________________ do hereby solemnly and sincerely declare, to the best of my knowledge and belief, as follows:

1. The statement signed bye me and dated the _______ day of _______ and attached hereto ans shown to me at the time of making this declaration is true.

2. The description of the trade mark in such statement is true description of the trade mark for the  registration of which I appply.

3. I am lawfully entitled to the use of the trade mark of which the said description is a true description.

                                                                          (Signature)

Notarial Certification

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Prepared by Beth Anne Gray J. 

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updated 14-Jan-2007