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Back to Forms for 'Patents'.





Mark:  _________________________


Registration Number:  ______________________________


Class Number:  ___________________________________




State of:   ________________________________________________


County of:  ______________________________________________


__________________________________ (Name of Registrant or Person Authorized to Sign for Registrant), being duly sworn, states that: 


1.  _________________________ (Name of Registrant (Current Owner)) owns the above identified registration issued on __________ (Date) and published under Section 12(c) on ____________ (date), as shown by records in the Patent and Trademark Office;


2.  The mark shown therein has been in continuous use in __________________ (Type of Commerce) commerce for five consecutive years from __________ (Date) to the present, on each of the following goods recited in the registration:  ___________________________________________________________ (List Goods)


3.  Such mark is still in use in ____________________________ (Type of Commerce) commerce;

4.  There has been no final decision adverse to registrant’s claim of ownership of such mark for such goods or services, or to registrant’s right to register the same or to keep the same on the register; and


5.  That there is no proceeding involving such rights pending and not disposed of either in the Patent and Trademark Office or in the courts.




_____________________________                       _____________________

Signature                                                                   Date



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