Free 635_0117.p65 - Iowa

MICHAEL A. MAURO Secretary of State State of Iowa
The applicant with the Secretary of State under number registration. Address of Applicant:
Street City

Application for Renewal of Registered Mark
One actual facsimile or specimen of mark must accompany this application

is the owner of a mark which has been registered and hereby makes application for renewal of the

County

State

ZIP

Indicate One: (A) Individual If B, state names and addresses of partners:

(B) Partnership

(C) Corporation

If C, state where incorporated: Description of mark

The mark described above is still in use by the applicant in the state of Iowa and in the state(s) of :

I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the preceding is true and correct.

Signed:

Title:

Date:

NOTES: 1. The application fee is $10.00. Make checks payable to SECRETARY OF STATE. 2. The information you provide will be open for public inspection under Iowa Code section 22.11 SECRETARY OF STATE Business Services Division Lucas Building, 1st Floor Des Moines, Iowa 50319 Phone: (515) 281-5204 FAX: (515) 281-7142 or (515) 242-5953

635_0117 rev 04/07