Attestation: According to federal regulations, this form must be signed by an owner/officer/partner/agent of the Licensee. For more information about rates and terms for Business Establishment Services, see 37 CFR Part 380 Subparts A and B.
I, the undersigned owner/officer/partner/agent of the Licensee, have examined this Statement of Account and hereby state that it is true, accurate, and complete to my knowledge after reasonable due diligence and that it fairly represents, in all material respects, the liabilities of the Licensee pursuant to 17 U.S.C. 112(e) and 114 and applicable regulations adopted under those sections.