SIGNED DECLARATION OF PROOF OF USE I, (Full Name of Mark Holder/Licensee) , hereby certify that the information submitted into the Mark Validation System, is, to the best of my knowledge complete and accurate, that the marks submitted to the Mark Validation System (by me or by my agent as the case may be), is, to the best of my knowledge currently in use in the manner set forth in the accompanying documented proof, in connection with the class of goods or services specified when this submission was made to the Mark Validation System; that this information is not being presented for any improper purpose; and that if, at any time, the information contained in this submission is no longer accurate I will notify the Mark Validation System within a reasonable time of that information which is no longer accurate, and to the extent necessary, update and, if required, provide additional information necessary for the submission to be accurate. Signature Date _______________ ________________ Mark Validation System Signed Declaration of Proof of Use