Response to Office Action Page 2 of 3
Declaration Signature
If the applicant is seeking registration under Section 1(b) and/or Section 44 of the Trademark Act, the applicant had a
bona fide intention to use or use through the applicant‘s related company or licensee the mark in commerce on or in
connection with the identified goods and/or services as of the filing date of the application. 37 CPR. Secs. 2.34(a)(2)(i);
2.34 (a)(3)(i); and 2.34(a)(4)(ii). If the applicant is seeking registration under Section 1(a) of the Trademark Act, the
mark was in use in commerce on or in connection with the goods or services listed in the application as of the application
filing date. 37 C.F.R. Secs. 2.34(a)(1)(i). The undersigned, being hereby warned that willful false statements and the like
so made are punishable by fine or imprisonment, or both, under 18 U.S.C. §1001, and that such willful false statements
may jeopardize the validity of the application or any resulting registration, declares that he/she is properly authorized to
execute this application on behalf of the applicant; he/she believes the applicant to be the owner of the trademark/service
mark sought to be registered, or, if the application is being filed under 15 U.S.C. §1051(b), he/she believes applicant to
be entitled to use such mark in commerce; to the best of his/her knowledge and belief no other person, firm, corporation,
or association has the right to use the mark in commerce, either in the identical form thereof or in such near resemblance
thereto as to be likely, when used on or in connection with the goods/services of such other person, to cause confusion, or
to cause mistake, or to deceive; that if the original application was submitted unsigned, that all statements in the original
application and this submission made of the declaration signer’s knowledge are true; and all statements in the original
application and this submission made on information and belief are believed to be true.

Signature:
Date:
Signatory’ Name: Richard F. Hickok
Signatory’ Position: Applicant

NOTE TO APPLICANT: When filed as part of the electronic form (i.e., scanned and attached as an image file), the
signature page must include both the signature information and the boilerplate declaration language. Do not include the
entire application, but do ensure that the boilerplate declaration language actually appears; a signature by itself will not
be acceptable. If, due to browser limitations, the boilerplate declaration language appears on a previous page when
printed, you must “merge” the declaration and signature block onto a single page prior to signing, so that the one
complete page can be scanned to create an acceptable image file. It is recommended that you copy—and—paste the entire
text form into another document, manipulate the spacing there to move the declaration and signature section to a separate
page, and then print this new version of the text form to send to the signatory.

http://teasroa.uspto.gov/roa/xslt.service?xsl=hsign 6/28/2007