Please note that the below statement verifying proof of use is slightly different than the standard substitute specimen statement.
The following statement and declaration under 37 C.F.R. §2.20 can be used to verify the use of the mark as evidenced by the item(s) submitted as proof of use, if properly signed and dated:
The owner or holder/owner was using the mark in commerce on or in connection with the goods and/or services identified in the registration for which use of the mark in commerce is claimed, as evidenced by the submitted proof of use, during the relevant period for filing the affidavit of use.
The signatory being warned that willful false statements and the like are punishable by fine or imprisonment, or both, under 18 U.S.C.
§1001, and that such willful false statements and the like may jeopardize the validity of this submission, declares that the facts set forth above are true; all statements made of his/her own knowledge are true; and that all statements made on information and belief are believed to be true.
Signature of Authorized Person
Type or Print Name