Form F0023 - Application To Register Or Renew Trade And Service Marks 1996 Page 4
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4F0023 - Page 4 of 4
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
P.O. BOX 136, JACKSON, MS 39205-0136
(601) 359-1333
*0023-4-4*
Application to Register or Renew Trade and Service Marks
ACKNOWLEDGMENT
State of
County of
I,
being first duly sworn, depose and
say that I am
of
the applicant herein, and that I make this affidavit and verification subject to the perjury laws on
and have the authority
the behalf of
to make this affidavit
and I have read the above and foregoing application and know the contents thereof, and that the
facts set herein are true.
I further depose and say that the three specimens filed herein are true and correct.
Signature of Applicant
Sworn to and subscribed before me this
day of
,
Notary
Notary
Seal
Signature
My commission expires
page 4 of 4
F0023 [Rev. 11/96]
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