Legal Statement of Registration

LEGAL STATEMENT OF REGISTRATION

This Legal Statement of Registration ("Statement") is entered into by and between Registrant Name: with principal address: and Registrar Name: with principal address: effective as of:

RECITALS

WHEREAS, Registrant has submitted documents, applications, or other materials for the purpose of registering certain registrable interests or assets as described below; and

WHEREAS, Registrar maintains records and processes registrations and is authorized to accept, record, and certify registrations within the applicable jurisdiction or registry; and

WHEREAS, the parties desire to set forth the Registrant's statement attesting to the facts and particulars of the registration and to provide the Registrar with instructions and certifications necessary for entry into the official record.

NOW THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Statement, the following terms have the meanings set forth below:

"Registration" means the entry or recording of the Registrant's interest, asset, or instrument into the official registry maintained by Registrar as described in Section 2.

"Registrant" means the party identified above as Registrant and any successor or permitted assign.

2. STATEMENT OF REGISTRATION

Subject Matter of Registration: The Registrant hereby declares and certifies for the official record that the registrable subject matter is described as follows:

Registration Type: Trademark Business Entity Vehicle/Title Other If Other, specify:

Registration Number (if assigned): Date of Initial Filing: Jurisdiction/Territory:

3. REPRESENTATIONS AND WARRANTIES

The Registrant represents and warrants to the Registrar that:

(a) Registrant is duly authorized to execute and deliver this Statement and to make the certifications herein; the person executing this Statement on behalf of Registrant has full authority to bind Registrant;

(b) the information and documents submitted for registration are true, correct, and complete to the best of Registrant's knowledge and do not omit any material fact necessary to make such information not misleading;

(c) Registrant holds the rights, title, or other legal interest in the subject matter sufficient to support the requested Registration and such interest is not subject to any undisclosed liens, encumbrances, or adverse claims except as disclosed in writing to Registrar.

4. RECORDING, CERTIFICATION, AND RELIANCE

Registrar may accept this Statement for recordation and, upon recording, may issue a certificate or certified copy evidencing the Registration. Registrar may rely upon the representations contained in this Statement in creating the official record and shall have no obligation to verify asserted factual matters beyond the documents and information presented by Registrant.

Registrant acknowledges that third parties may rely upon the official record and agrees to indemnify and hold harmless Registrar from liability arising from Registrant's inaccuracy, misrepresentation, or failure to disclose material information in connection with this Statement, except to the extent caused by Registrar's gross negligence or willful misconduct.

5. FEES AND COSTS

Registrant shall be responsible for any fees, filing costs, taxes, or charges required for the processing, recording, or certification of the Registration. Unless otherwise agreed in writing, Registrar may refuse to record or certify until such fees and costs have been paid in full.

6. NOTICES

All notices, requests, demands and other communications required or permitted under this Statement shall be in writing and delivered to the addresses set forth below:

7. GOVERNING LAW; VENUE

This Statement shall be governed by and construed in accordance with the laws of the jurisdiction in which the Registration is to be recorded, without regard to conflict of law principles. The parties submit to the exclusive venue of the courts located in that jurisdiction for any action arising out of or relating to this Statement.

8. ENTIRE AGREEMENT; SEVERABILITY

This Statement constitutes the entire agreement between the parties with respect to the Registration and supersedes all prior and contemporaneous understandings and agreements, whether written or oral. If any provision of this Statement is found to be invalid or unenforceable, the remaining provisions shall continue in full force and effect and the invalid or unenforceable provision shall be reformed to the extent permissible to accomplish the original intent of the parties.

9. AMENDMENTS; WAIVER; COUNTERPARTS

Any amendment or modification of this Statement must be in writing and signed by duly authorized representatives of both parties. No waiver of any provision shall be effective unless in writing and signed by the party against whom enforcement is sought. This Statement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

10. CERTIFICATION

By signing below, the signatory on behalf of the Registrant certifies under penalty of perjury and other applicable law that the statements made in this Statement are true and correct to the best of the signatory's knowledge, information, and belief, and that the signatory is authorized to make such certification on behalf of Registrant.

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