MAILING ADDRESS: Commercial Recording Division Connecticut Secretary of the State P.O. Box 150470 Hartford, CT 06115-0470 860-509-6003
OFFICE OF THE SECRETARY OF THE STATE
DELIVERY ADDRESS: Commercial Recording Division Connecticut Secretary of the State 30 Trinity Street Hartford, CT 06106 860-509-6003
NAME CHANGE OF REGISTERED MARK OWNER Filing Fee: $25.00 1. Current Name of Record Owner: Make Checks Payable to "Secretary of the State"
2. State of Formation of the Owner if other than a natural person:
3. Connecticut Registration Number: ____________________________
4. The name of the mark's owner been changed to:
EXECUTION: I hereby declare under the penalties of false statement that the statements made in the foregoing application is true.
5. ___________ Date
6. _______________________________ Name of Signatory
7. _____________________________ Title of Signatory if applicable
8. _________________________________________________________________ Signature 9. The owner must submit three specimens or photographs of the mark as actually used in this state.