(Author's full Name.)
NO. 5.—OATH OF APPLICANT FOR CERTIFICATE OF COPYRIGHT.
| Hawaiian Islands, | } | ss. |
| Island of —————— |
————, the above named Petitioner, residing at ————, being duly sworn, deposes and says, that he is the original and first author of ———— (describe the article) ———— in the foregoing petition mentioned, and that he is a citizen (or subject) of ————.
(Author's full Name.)
Sworn to and subscribed before me,
this ———— day of ————, A. D. 18—.
[L. S.] (Signature of Notary.)
(See Rule [23].)