Trademark And/or Service Mark Renewal Form Page 5
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5STATE OF _______________________
SS:
COUNTY OF _____________________
_________________________________________________, being duly sworn, deposes and
says that he is _______________________________________________________________,
of the above named applicant, that the statements contained in the foregoing statement are
true and that he verily believes that said applicant is the owner of the mark sought to be
renewed and that no other person has the right in the State of Delaware to use such mark
either in the identical form thereof or in such resemblance thereto, as might be calculated to
deceive or to be mistaken therefor.
__________________________
SIGNATURE OF APPLICANT
Subscribed and sworn to before me this _________________ day of __________________,
20____.
__________________________
Notary Public
NOTARY SEAL
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