APPLICATION
FOR REGISTRATION OF TRADEMARK
To: The Secretary of State of the State of
________________________________________
The
undersigned applies to register the trademark described herein pursuant to
________________________________ (Cite Statute), and affirms under the
penalties of perjury that the statements made herein and on the papers attached
hereto are true.
Name
of applicant:
_____________________________________
Address:
_________________________________________________________________
If
corporation, state of incorporation:
___________________________________________
If
partnership, names and addresses of all partners:
__________________________________________________________________________
Description
of trademark:
____________________________________________________
Specific
goods or services on or in connection with which the trademark is used: __________________________________________________________________________
Manner
in which trademark is placed on goods or otherwise used in connection with
applicants goods or services:
__________________________________________________
Name
of class and classification number of goods or services: _______________________
Date
of first use of trademark:
_____________________
In
State of:
________________________________ _______________
(Date).
Elsewhere: ________________________________ _______________
(Date).
Send
certificate of registration and communications with respect to this application
to:
____________________________________________________________ (Name and
Mailing Address of Applicant or Agent Authorized to Prosecute Application).
Applicant
is the owner of the trademark described herein, and no other person has the
right to use such trademark in this state, either in the identical form or in
such near resemblance thereto as might be calculated to deceive, or be mistaken
for, such trademark.
Three
samples or facsimiles of such trademark are attached hereto.
___________________________________ __________________
Signature Date
