Petition to cancel registration. In the Matter of Registration No. _________. Date of issue _________. _________[Name of petitioner] v. _________[Name of registrant] Cancellation No. _________[to be inserted by Patent and Trademark Office] _________[name of petitioner], a[n] _________[legal entity of petitioner], located and doing business at _________[street, city and state], believes that petitioner is or will be damaged by the above-identified registration, and here petitions to cancel that registration. As grounds for the cancellation, it is alleged that: [Numbered paragraphs should state the grounds and recite facts tending to show why petitioner believes that petitioner is or will be damaged.] State of _________ ss County of _________
_________[name of petitioner or of person authorized to sign for petitioner] states that he/she is the petitioner named in the above petition to cancel, or is the person authorized to sign for the juristic petitioner named in this petition to cancel; that he/she has read the petition to cancel and knows the contents of it; and that the allegations are true, except as to the matters stated in the petition to be upon information and belief, and as to those matters he/she believes them to be true. _________(Signature of petitioner to cancel) [If petitioner is a corporation or other juristic organization, give the official title of the person who signs for petitioner.] Declaration