Free Trademark or Servicemark Application - Illinois

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State of Illinois Trademark or Servicemark
Application TM/SM-15
Mailing Address:
Secretary of State Department of Business Services Trademark Division Rm. 330 Howlett Building Springfield, IL 62756 217-524-0400 www.cyberdriveillinois.com Application must be typed or legibly printed in black ink. Three examples of the mark must accompany the application. Do not attach examples with staples, glue or tape. A $10 registration fee is required in the form of a check or money order payable to Illinois Secretary of State. See instruction page for additional information.

This space for use by Secretary of State.

Items 1-4 refer to Registrant 1. Name of Registrant (Owner of the Mark):______________________________________________________________ 2. Mailing Address: ________________________________________________________________________________
Street

______________________________________________________________________________________________
City, State, ZIP Code

3. Registrant is a (check one): Corporation Union General Partnership Limited Liability Partnership (LLP) Individual Association Limited Partnership (LP) Limited Liability Company (LLC) Other (specify): _______________________________________________________________________________ 4. a) If a Corporation, LP, LLP or LLC, State in which it is organized: __________________________________________ b) If an LP or LLP, Name of one of the General Partners: _________________________________________________

5. Name of Mark: __________________________________________________________________________________ Mark is a (check one): Word Mark only Word with Design/Logo Design/Logo only If the mark involves a design/logo, describe major features of the mark: ______________________________________ ______________________________________________________________________________________________ 6. Describe the specific goods or services in connection with which mark is used (provided by the mark): ______________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

Printed by authority of the State of Illinois. November 2008 -- 1 -- C 246.8

7. Classification Number: ___________ (One classification number only; refer to listing. The Secretary of State will assign a classification number if none is given and has the right to change the classification if that provided by the applicant is incorrect. Each classification requires a separate application, set of three specimens and a $10 filing fee.) 8. a) If a Trademark, check how the mark is used (check as many as apply). Mark is applied: directly to the goods on documents, wrappers or articles delivered in connection with the service rendered in another fashion; please specify: ________________________________________________________________ OR b) If a Servicemark, check how the mark is used (check as many as apply). Mark is displayed: in advertisements of the service on documents, wrappers or articles delivered in connection with the service rendered in another fashion; please specify: ________________________________________________________________ 9. Date of first use of mark by applicant or predecessor. Mark must be used in Illinois prior to registration. (If first use of mark was in Illinois, use the same date in both a and b.) a) Anywhere: _____________________________________ b) In Illinois: _____________________________________
Month, Day, Year Month, Day, Year

10. State any knowledge of previous owners or users of the mark; including the name of any such owners/users. If there is no knowledge of previous use, please answer N/A._____________________________________________________________ The applicant hereby appoints the Illinois Secretary of State as agent for service of process in an action relating only to the registration, which may be issued pursuant to this application, if the registrant is, or shall become, a non-resident individual, or foreign partnership, limited liability company, association or corporation not licensed to do business in the State, or cannot be found in this State. The undersigned hereby declares, under penalties of perjury, that the statements made in the foregoing application are true, and that to his/her knowledge no other person has registered the mark, either federally or in this State, or has the right to use the mark 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.

X
Signature of Applicant Typed or Printed Name of Applicant

Official Capacity

Contact Phone Number

Printed by authority of the State of Illinois. November 2008 -- 1 -- C 246.8

Instructions for Completing Registration Application
1. Provide the name of the registrant/owner of the mark. The registrant may be an individual, corporation or other type of business entity. 2. Provide the business/mailing address where renewal correspondence should be sent. 3. Mark the appropriate box for the type of ownership of the mark; i.e., if the registrant indicated in item 1 is an Individual, item 3 should be marked Individual. 4. Complete item 4a or 4b only if the registrant is one of the business entities listed in item 3. 5. Provide the name of the mark and clearly indicate the type of mark. If the mark includes a design or logo, a brief description must be included. Please note that stating "see attached" is unacceptable. 6. Provide a description of the goods or services provided by the mark. A trademark represents the name of a product or product line, or a logo or tagline for the product or product line. A servicemark represents the name of a business that provides services, or a logo or tagline for such services. 7. Provide classification number (refer to listing). Only one classification number may be given on each application. If a classification number is not provided, the Secretary of State's office will assign a class number and has the right to change the classification if the number provided is incorrect. Each classification requires a separate application, specimens and fee. 8. Check as many as apply in item 8a or 8b. 9. Provide the date of first use of the mark. Both dates must be fully stated and include month, day and year. If the first use was in Illinois, items 9a and 9b should contain the same date. The mark must be in use in commerce within Illinois prior to registration. 10. State any knowledge of previous owners or users of the mark. Signature and Contact Information The registrant or the attorney-in-fact for the registrant must sign the form. The capacity in which the person is signing must be provided (i.e., registrant, officer, attorney-in-fact). Photocopied, stamped or faxed signatures are unacceptable. Specimens The registration application must be accompanied by three examples of the mark showing actual use in commerce in the state of Illinois. For trademarks, examples may include the product label, business cards, letterhead or advertisements. For servicemarks, examples may include business cards, letterhead, brochures, flyers or advertisements. Name/tagline/logo printed, written or drawn on plain paper are unacceptable. If color is a feature of the mark, specimens reflecting the actual color(s) must be submitted. Duration and Renewal Registrations are effective for five years. A Renewal Notice and Renewal Application are sent to the registrant at the registered address. If there is a change of address, it is the responsibility of the registrant to notify the Secretary of State's office. Renewals may be submitted no more than 60 days prior to the expiration date. The expiration date is the date of original registration.

Printed by authority of the State of Illinois. November 2008 -- 1 -- C 246.8

Classification of Goods and Services
General classes of goods and services are established for convenience of administration of this Act, not to limit or extend the applicant's or registrant's rights. A single application for registration of a mark may include any or all goods or services upon which the mark is actually being used and which are comprised in a single class. In no event shall a single application include goods or services upon which the mark is being used and which fall within different classes. Classification of Goods for Trademarks 1 2 3 4 5 6 7 8 9 10 11 Chemicals Paints Cosmetics and cleaning preparations Lubricants and fuels Pharmaceuticals Metal goods Machinery Hand tools Electrical and scientific apparatus Medical apparatus Environmental control apparatus 12 13 14 15 16 17 18 19 20 21 22 23 Vehicles 24 Firearms 25 Jewelry 26 Musical instruments 27 Paper goods and printed matter 28 Rubber goods 29 Leather goods 30 Non-metallic building materials Furniture and articles not otherwise classified 31 Housewares and glass 32 Cordage and fibers 33 34 Yarns and threads Fabrics Clothing Fancy goods Floor coverings Toys and sporting goods Meals and processed foods Staple foods Natural agricultural products Light beverages Wine and spirits Smoker's articles

Classification of Services for Servicemarks 35 Advertising and business 39 36 Insurance and financial 40 37 Building construction and repair 41 38 Telecommunications 42

Transportation and storage Treatment of materials Education and entertainment Computer and Scientific

43 Restaurants and hotels 44 Medical, veterinary, beauty care and forestry 45 Personal, Legal and Security

Printed by authority of the State of Illinois. November 2008 -- 1 -- C 246.8