FOR REGISTRATION OF TRADEMARK
To: The Secretary of State of the State of
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.
corporation, state of incorporation:
partnership, names and addresses of all partners:
goods or services on or in connection with which the trademark is used: __________________________________________________________________________
in which trademark is placed on goods or otherwise used in connection with
applicants goods or services:
of class and classification number of goods or services: _______________________
of first use of trademark:
Elsewhere: ________________________________ _______________
certificate of registration and communications with respect to this application
____________________________________________________________ (Name and
Mailing Address of Applicant or Agent Authorized to Prosecute Application).
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.
samples or facsimiles of such trademark are attached hereto.