Free MARK 4 - Maine

Filing Fee $40.00

MARK
STATE OF MAINE

APPLICATION FOR ASSIGNMENT

Deputy Secretary of State A True Copy When Attested By Signature

Pursuant to 10 MRSA §1525, the undersigned hereby applies to the Secretary of State of Maine to assign the following mark:

Deputy Secretary of State

CAREFULLY READ ALL OF THE INSTRUCTIONS BEFORE YOU COMPLETE THIS FORM. THIS ASSIGNMENT SHOULD BE RECORDED WITH THE SECRETARY OF STATE WITHIN 3 MONTHS A. B. CHARTER NUMBER (if known) ____________________ Amendments to TEXT and FEATURES of the mark are NOT permitted. 1. TEXT - list word(s) protected in the original registration, if any (if none, so indicate): ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 2. FEATURES - describe in detail the design protected in the original registration, if any (if none, so indicate): ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ C. Amendments to Type of Mark must be made on Form No. MARK-3 or, at the time of Renewal, on Form No. MARK-2. TYPE OF MARK: ___________________________

D.

ASSIGNOR 1. Assignor Name and Address _______________________________________________________________________________________________ _______________________________________________________________________________________________ 2. Assignor is a (an) ! association ! individual ! union ! general partnership ! limited partnership ! corporation

! other __________________________________________________ (Explain)

If a corporation, limited partnership, limited liability company or limited liability partnership the state of incorporation/organization is _____________________________ and the date of incorporation/organization is ________________________ 3. Whereas, I ______________________________________________________________________________ believe (Print/Type Name and Capacity) _______________________________________________________________________________________________ ("Myself", Firm, Association or Corporate Name) to be the owner of the aforesaid mark, and state that for good and valuable consideration, the receipt of which is hereby acknowledged, said owner has sold, assigned and transferred on (date) ____________________ the entire right, title and interest together with the good will of the business in connection with the aforesaid mark to the assignee herein. 4. E. Dated: ________________________ Signature __________________________________________________

ASSIGNEE 1. Assignee Name and Address _______________________________________________________________________________________________ _______________________________________________________________________________________________ 2. Assignee is a (an) ! association ! individual ! union ! general partnership ! limited partnership ! corporation

! other __________________________________________________ (Explain)

If a corporation, limited partnership, limited liability company or limited liability partnership the state of incorporation/organization is _____________________________ and the date of incorporation/organization is ________________________ 3. Dated: _________________________ Signature _________________________________________________ (Signature and Capacity)

You MUST submit THREE (3) samples of the mark text and/or design with this application. If the mark is to be protected in color, all the samples must be in the appropriate colors. NOTE: Samples may be 3 of the same item, i.e. business cards, letterhead, etc. THE EXECUTION OF AN APPLICATION CONTAINING FALSE STATEMENTS WHICH ONE DOES NOT BELIEVE TO BE TRUE IS PUNISHABLE AS A CLASS D CRIME ACCORDING TO THE MAINE CRIMINAL CODE, 17-A MRSA §453, "UNSWORN FALSIFICATION".

SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MARK-4 Rev. 4/16/2001 TEL. (207) 624-7752

INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR ASSIGNMENT OF A MARK
Be sure to read Chapter 280 (Rules for Marks Registered Under Title 10, Chapter 301-A) and review the list of class numbers for marks (goods and services) before completing the application for assignment. The proper fee for filing is $40.00 . You MUST submit THREE (3) samples of the mark text and/or design with this application. If the mark is to be protected in color, all the samples must be in the appropriate colors. NOTE: Samples may be 3 of the same item, i.e. business cards, letterhead, etc.

THE FOLLOWING ARE ADDITIONAL INSTRUCTIONS FOR COMPLETING THE FORM. A. CHARTER NUMBER: If you do not know the charter number, leave it blank and this office will complete it for you.

B.

TEXT AND FEATURES The text and/or features that you list must be exactly the same as on your original application. You cannot make any changes to them.

C.

TYPES OF MARKS: Trademark - a mark applied to goods the applicant manufactures or sells. Service Mark - a mark used in connection with the services the applicant provides. Combined Service/Trademark - a mark applied to goods and used in connection with services provided by the applicant. Certification Mark - a mark used by one or more persons other than the owners to certify the characteristics of goods and services provided by others. Collective Mark - a mark used by members of a collective organization in connection with goods or services to indicate membership.

D.

ASSIGNOR - NAME, ADDRESS AND CAPACITY: Type or print the name and address of the assignor. Check the box that applies to you. If you check "other", be sure to explain who (what type of entity) the assignor is. If the assignor is a corporation, limited partnership, limited liability company or limited liability partnership, please add the state of incorporation/organization and the date of incorporation/organization. Type or print the name and capacity of the person signing. If the assignor is a

corporation, the person signing must be an officer of the corporation and must provide a corporate title. If the assignor is a type of entity other than a corporation, the person signing must provide a capacity which empowers him or her to sign on its behalf. Provide the date (month, day and year) on which the mark was assigned. The assignor must sign and date (month, day and year - this date must not be earlier than the date of the assignment) the application.

E.

ASSIGNEE - NAME, ADDRESS AND CAPACITY: Type or print the name and address of the assignee. Check the box that applies to you. If you check "other", be sure to explain who (what type of entity) the assignee is. If the assignee is a corporation, limited partnership, limited liability company or limited liability partnership, please add the state of incorporation/organization and the date of incorporation/organization. The assignee must sign indicating the capacity under which they are signing and date (month, day and year) the application. If the assignee is a corporation, the person signing must be an officer of the corporation and must provide a corporate title. If the assignee is a type of entity other than a corporation, the person signing must provide a capacity which empowers him or her to sign on its behalf.

PLEASE NOTE:

This office does not give legal advice, however, a corporate examiner is always available to assist you in completing any of our forms.

Submit the completed form to: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 TEL. (207) 624-7752 Mark Assignment Instructions Rev. 4/16/2001