Click on the Browse/Choose File button to select file that contains the scanned declaration/signature from your local drive. The scanned file should only include the declaration language with the appropriate
signature information (signature, signatory's name, signatory's position, and signature date). Do not include the entire application, but do ensure that the declaration language appears; i.e., a signature by itself
is not acceptable absent the required declaration language.
NOTE: Only one signature is required, regardless of the number of owners/holders. If necessary, the actual signatory may complete the following fields directly on the Text Form, if you do not know who will be
signing the form. If left blank, you will initially receive a WARNING message, which you can by-pass by clicking the "Continue" button. After receipt of the signed declaration, you must then use the information
provided therein to complete the fields for "Signatory's Name" and "Signatory's Position." At the time of final submission, these are mandatory fields, which will produce an ERROR if left blank.
Enter appropriate title or nature of relationship to the owner/holder.
If the signer is
- An individual owner/holder, enter "Owner" or "Holder" as appropriate.
- Joint individual owners/holders, enter "Owners" or "Holders" as appropriate.
- A business entity authorized signatory, enter official title; e.g., "President" (if a corporation),"General Partner" (if a partnership), or "Principal" (if a limited
liability company).
- A U.S.-licensed attorney, enter "Attorney of record," and if not specified in the application or prior communications, specify at least one state bar admission,
e.g., "Attorney of record, New York Bar member." Also, if the signing attorney is from the same U.S. firm as the attorney of record, but was not listed in the
original filing and is not otherwise of record, also include law firm name, e.g., Associate Attorney, Smith, Jones & Davis, Virginia Bar member.
SUBMISSION SIGNATURE
Click to choose ONE signature method:
Handwritten pen-and-ink signature
NOTE: Although a possible combination as selected on the form, the following signing method must NOT be used: declaration signed directly and submission signed through the email text form approach.
*You must click one of the three buttons below to confirm that you are legally authorized to sign this form based on the trademark rules governing representation of others before the USPTO.
If you have a U.S.
-licensed attorney representing you in this application, only your attorney can sign this response.
Owner/Holder who is not represented by an attorney (pro se): I hereby confirm that
• I am not represented by an attorney in this matter, and am either: (1) the owner(s)/holder(s); or (2) a person or persons(s) with legal authority to bind the owner(s)/holder(s); and
• If I had previously been represented by an attorney in this matter, either I revoked their power of attorney by filing a signed revocation with the USPTO or the USPTO has granted this attorney's withdrawal
request.
Click the above first button only if you are the owner(s)/holder(s) or legally authorized to bind the owner(s)/holder(s); such as an officer of the owner/holder corporation or association, or a general
partner of the owner/holder partnership.