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`> GearFi5h Bum .-» Skull Flag
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`Skull F1»-m
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`- Made of high quality |-reatheuvtreated
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`:» Gearaeach 3 SiunatureBeac|ITowel
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`Signature Beach Towel
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`Measures: 39 1»: 70
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`$40.00
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`
`
`Declaration
`
`Page 2 of 3
`
`Applicant requests registration of the above-identified trademarkfservice mark in the United States Patent and
`Trademark Office on the Principal Register established by the Act of July 5, 1946 ( I5 U.S.C. Section 1051 et seq., as
`amended}. Applicant is the owner of the marl: sought to be registered, and is using the mark in commerce on or in
`connection with the goods/services identified above, as evidenced by the attached specirnen(s) showing the mark as
`used in commerce.
`
`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. Section 1001, and that such willful false statements may jeopardize the validity
`of the form or any resulting registration, declares that he/she is properly authorized to execute this form on behalf of the
`applicant; hefshe believes the applicant to be the owner of the trademark/service mark sought to be registered; and that
`all statements made of his/her own knowledge are true; and that all statements made on information and belief are
`
`believed to be Tue.
`
`Signature See In :
`
`Signature:
`Signatory's Name: Ker h T. Combs
`Si gnatory's Position: Managing Director
`
`" ii’? ii 3
`Date Signed:
`Signatory's Phone:
`§;4—-- 24-1. '?’1- S-1’
`
`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 decimation language actually appears; at signature by ilsegfwfif
`not be acceptabie. 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, inanipuiate 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:/feteasuspto.govfaou/xslt.service?xsl=hsign
`
`lfl 7/2013

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