Free Microsoft Word - name chng of reg mark owner.DOC - Connecticut

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.

Rev. 08/24/2007