Free Microsoft Word - app for a cert of reg of trade or serv mark.DOC - Connecticut

MAILING ADDRESS: Commercial Recording Division Connecticut Secretary of the State P.O. Box 150470 Hartford, CT 06115-0470 860-509-6003

SECRETARY OF THE STATE OFFICE

DELIVERY ADDRESS: Commercial Recording Division Connecticut Secretary of the State 30 Trinity Street Hartford, CT 06106 860-509-6003

APPLICATION FOR A CERTIFICATE OF REGISTRATION OF A TRADE OR SERVICE MARK Filing Fee: $50.00 Make Checks Payable to "Secretary of the State"
1. Name of Owner of Mark: __________________________________________________________________________________ 2. Address of Owner: __________________________________________ __________________________________________ __________________________________________ (Street/City/State/Zip Code) 3. State or Country of Formation of the Owner, if other than a natural person: _____________________________________ (Partnerships ­ reference & attach 8 1/2x11 list of partners)

4. Please provide a complete description of the mark: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 5. The goods or services on or in connection with which the mark is used: ____________________________________________________________________________________________________ 6. Use this space to disclaim the exclusive right to use any descriptive, generic or
geographically descriptive components of the mark: 7. The Class of the goods or services stated in item number 5:

________________________________________________________

________________

_______________________________________________
NOTE: One application per good/service. 8. The date on which the mark was first used anywhere: __________________________________ (month/day/year) 9. The date on which the mark was first used in Connecticut: _______________________________ (month/day/year) 10. The mode, manner or method of applying, affixing or otherwise using the mark on or in connection with such goods or services: ____________________________________________________________________________________________________ 11. Have applications to register the mark or portions or composites thereof been filed in the United States Patent or Trademark Office? _____ 12. If No. 11 was answered Yes, indicate the filing date, serial number, status, and if registration was refused, the reasons for such refusal:
The applicant is the owner of the mark or the owner's representative. The applicant asserts that the mark is not known to be the subject matter of an existing federal registration granted to another and to the best of the applicant's knowledge, no other person has the right to use such mark in this state either in the identical form thereof or in such near resemblance thereto as to be likely, when applied to the goods or services of such other person, to cause confusion, or to cause mistake or to deceive purchasers. The applicant hereby declares under the penalties of false statement that the statements made in the foregoing application are true.

13. Date of Execution 14. ________________________________________ Name of Applicant if other than Owner _________________
month/day/year

15. _______________________________________ Print/Type name of signatory

___________________________________________ Title of signatory if applicable: _________________ ___________________________________________ 16. _______________________________________ Business Address of Applicant Signature

17. The applicant must submit three specimens or photographs of the mark as actually used in this state.
Please make appropriate reference to attachments if additional space is needed.
Rev. 08/24/2007

INSTRUCTIONS FOR THE COMPLETION OF THE APPLICATION FOR REGISTRATION OF A CONNECTICUT TRADE OR SERVICE MARK

The following series of instructions have been compiled to assist you in completing the Application for Registration of a Connecticut Trade or Service Mark form. Numbers appearing on this instruction correspond with numbered blanks appearing on the form. Examples provided in these instructions are fictitious and have been included to illustrate applications of the instructions provided. 1. 2. 3. Name of Owner of Mark - Provide full legal name of the individual or organization who or which actually owns the mark. Address of owner of Mark - Provide full street address of mark's owner. Include street, city, state and zip code. State or Country of Formation of the Owner - Complete only if owner is not a natural person by providing the owner's state of formation. A. 4. Note: if the owner of the mark is a partnership, it must attach a list of its partners to the application.

Description of the Mark - Provide in words, a full description of the mark intended to be registered. A. If the mark is composed of words alone, the description need only restate those words. 1. B. Example - The mark is SPINTECH. The description is SPINTECH.

Logos, pictorial features, colors, or distinctive print styles, which are components of the mark, must be described in writing. 1. Example description - SPINTECH appearing in yellow block letters in the center of three horizontally arrayed silver gears.

C.

Please note that the written description defines the registration. All searches conducted by this office are based upon the written description. It is important, therefore, to include all relevant description of the mark in item number 4. Drawings or references to attached specimens will not substitute for a full written description and must not appear in item number 4.

5.

The goods or services on or in connection with which the mark is used - Provide the type of the goods or services, which the mark identifies. This is usually a description of what the owner produces, e.g., Tires for a manufacturer of Tires - Real Estate Services for a Real Estate Agency. Disclaimers - The exclusive right to use any generic, descriptive or geographically descriptive terms or features of the mark must be disclaimed on the application. If such terms or features are not disclaimed, the application will have to be returned for correction. Whether or not components of a mark must be disclaimed depends largely upon the goods or services in connection with which it is used. A. Example 1. 2. 3. The mark is described as: The words "Quickie Grocery of Meriden" contained within a bright orange triangle. The services in connection with which the mark is used is: Grocery store services. The disclaimer required is: The owner hereby disclaims the exclusive right to use the terms "Grocery" and "Meriden".

6.

Rev. 08/24/2007

Page 2
7. The class of goods or services - Select from the list of classes provided in section 35-11h of the Connecticut General Statutes. (this list has been reproduced for your convenience and included within the application package). A. Select the class into which the goods or services stated in item number 7 fall. If your mark identifies goods, select a class from the group of trademark classes only. Otherwise, if your mark identifies services, select a class from the group of service mark classes only. If you cannot find a class into which your mark falls please choose the appropriate miscellaneous class, 20 for goods, 42 for services. Only one class may be selected per application. Separate applications must be completed for marks, which identify multiple classes of goods or services.

B. C.

8.

The date on which the mark was first used anywhere - Provide month, day and year of the mark's first use anywhere. A. The date of first use anywhere must precede the date on which the application is submitted.

9.

The date on which the mark was first used in Connecticut -Provide month, day and year of the mark's first use in Connecticut. A. The date of first use in Connecticut must precede the date on which the application is submitted.

10.

The mode, manner or method of applying, affixing or otherwise using the mark - Provide the answer to the question: where is the mark placed to identify the goods or services. A. EXAMPLE - The mark appears on signs, in magazine advertisements and on product labels.

11.

Application for registration of the mark with the United States Patent and Trademark office - Answer the question provided in this item "yes" or "no". Specific information regarding registration of the mark with the United States Patent and Trademark Office A. B. Complete only if the answer to the question presented in item number 11 is "yes". Provide all of the requested information.

12.

13. 14.

Date of Execution: Provide the date on which the application is signed. Name of Applicant: A: If the owner is applying for registration of the mark, skip over number 14. B. If the applicant is a person other than the owner, supply the applicant's full legal name and complete business address.

15.

Name of Signatory: Print or type the name of the signatory. A. B. If the owner/applicant is a natural person, leave the Title line blank If the owner/applicant is not a natural person, e.g. a corporation, limited liability company, etc., provide the signatory's title on the Title line.

16. 17.

Signature - The signatory named in item number 15 must provide an original signature. Specimens or photocopies of the mark - All applications must include three identical specimens of the mark or three identical photographs showing the mark as actually used. Examples of specimens include product labels, advertisements, flyers, etc. Please note that specimens which are derived from newspaper advertisements are not acceptable because they will decay and cannot be maintained as part of this office's permanent records. A. B. The specimens or photographs should not be attached to the application. The specimens or photographs should not be larger than 3" X 3".

Use attachments where space provided is inadequate.

Trade/Service Marks, See Title 35 of the Connecticut General Statutes STATUTORY CLASSES The following is a list of all statutory classifications for Connecticut Trade and Service Marks. From one of the two possible categories, goods or services, please make the appropriate selection and state the class chosen on the application. Note: trademark registrants may only select from classes of goods and service mark registrants may only select from classes of services. If the goods or services in connection with which your mark is used do not fit squarely within the appropriate list of classes below, please consider selecting one of the miscellaneous classes (20 for goods, 42 for services). See Connecticut General Statute section 35-11h. GOODS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Chemicals Paints Cosmetics and Cleaning Preparations Lubricants and Fuels Pharmaceuticals Metal Goods Machinery Hand Tools Electrical and Scientific Apparatus Medical Apparatus Environmental Control Apparatus Vehicles Firearms Jewelry Musical Instruments Paper Goods and Printed matter Rubber Goods 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. SERVICES 35. 36. 37. 38. Advertising and Business Insurance and Financial Construction and Repair Communication 39. 40. 41. 42. Transportation and Storage Material Treatment Education and Entertainment Miscellaneous Leather Goods Nonmetallic Building Materials Furniture and Articles not Otherwise Classified Housewares and Glass Cordage and Fibers Yarns and Threads Fabrics Clothing Fancy Goods Floor Coverings Toys and Sporting Goods Meats and Processed Foods Staple Foods Natural Agricultural Products Light Beverages Wines and Spirits Smokers' Articles

Rev. 08/24/2007