CORPORATION COMBINED AFFIDAVIT

USE AND INCONTESTABILITY

Mark: ______________________________________________

Registration Number: _________________________________

Class Number: ______________________________________

TO THE COMMISSIONER OF PATENTS AND TRADEMARKS:

State of: __________________________________________

County of: ________________________________________

________________________________________ (Name of Corporate Officer) being duly sworn, states that:

1. __________ (He or She) is the _____________________________ (Secretary) of ________________________________ (Corporation), a corporation duly organized under the laws of the State of ______________, located and doing business at __________________________________________________________ (Address);

2. __________ (He or She) believes that such corporation is the owner of Registration Number _______________________________________________;

3. The mark described therein has been in continuous use in ____________________ (Interstate) commerce from __________ (Date) in connection with the following goods specified in the registration, namely, ________________________;

4. The mark is still in use in ____________________________ (Interstate) commerce on or in connection with the goods specified in the registration;

5. The mark is used by _________________________________ (Printing the Mark on the Goods), and the attached specimen shows the mark as currently used on or in connection with the goods;

6. There has been no final decision adverse to the registrant’s claim of ownership of such mark for such goods or its right to register the same or keep the same on the register, and there is no proceeding involving such right pending in the United States Patent and Trademark Office or in a court and not finally disposed of.

___________________________________________________________

Name of Corporation

By _________________________________________________________

Signature and Title