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Office of the Secretary of State Corporations Section P.O. Box 13697 Austin, Texas 78711-3697
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TRANSFER OF TRADEMARK OWNERSHIP/ CHANGE OF REGISTRANT'S NAME AND REQUEST FOR NEW CERTIFICATE OF TRADEMARK REGISTRATION
1. Applicant is the owner of the following trademark or service mark that is registered with the Secretary of State. Description of the mark: Registration Number: Date of Registration: Name of Registrant of Record: Address of Registrant of Record: 2. Check the appropriate item below. Ownership of the registered mark has been transferred to The name of the registrant has been changed to Name: Address: The instrument identified below that transferred ownership of the mark or changed the registrant's name was filed on the date shown with the filing office indicated. A certified copy of the instrument is attached hereto. Document: Date of Filing: Filing Office: or A certified copy of the instrument is not attached because: The instrument is not required to be filed or recorded. The instrument is on file with the Secretary of State of Texas. 4. Registrant requests that a new certificate of registration be issued for the remainder of the term of registration. Yes (Additional fee required) No

3.

(Signature on reverse of form)

Signed on this

day of

,

Current Registrant (Typed or Printed Name)

Signature of Current Registrant

INSTRUCTIONS
1. This form is to be used when ownership of a registered trademark or service mark is transferred, or when a registrant's name is changed during the period of registration. Upon request, a new certificate of registration will be issued in the name of the transferee or in the new name of the registrant. The new certificate will be for the remainder of the unexpired term of the mark's registration. The fee for filing this form is $10.00. If the registrant requests a new certificate of registration by checking "yes" in item 4, an additional fee of $10.00 must be submitted. This form and a certified copy of the instrument effecting the change of ownership or change of name should be submitted along with the required filing fee to: Secretary of State, Corporations Section, Attn: Trademark Examiner, P.O. Box 13697, Austin, Texas 78711. The delivery address is 1019 Brazos, Austin, Texas 78701. If the document effecting the change is not required to be filed or recorded but it is the type of document which would be filed in the records of the Secretary of State if the registrant was a corporation, a copy of the document should be submitted along with this form. A corporation or other business entity which has filed the document effecting the change with the Secretary of State of Texas must identify the document filed and the date of its filing with the Secretary of State, and need not attach a certified copy of the document.

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Form No. 904 Revised 8/99