Free Microsoft Word - chng of address for 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

CHANGE OF ADDRESS FOR REGISTERED MARK OWNER Filing Fee: $25.00 1. 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. New Address of Mark Owner:

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

Rev. 08/24/2007