Appendice 7. Sample Section 1746 Declaration

• Pages: 1-1

APPENDIX 7 7-1

Sample Section 1746 Declaration

Declaration Pursuant To 28 U.S.C. § 1746

I, John J. Jones, Vice President of Acme, Inc., hereby certify that an

agreement in principle dated September 1, 2012 (a copy of which is

submitted herewith) has been entered into between Acme, Inc. and

Amalgamated, Inc. concerning the transaction that is the subject of the

accompanying Notification and Report. Subject to the terms and

conditions of the agreement in principle, it is the good faith intent of

Acme, Inc. to complete this transaction.

I declare under penalty of perjury that the foregoing is true and

correct. Executed on September 5, 2012.

John J. Jones