Free Microsoft Word - assignment of registered mark.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

ASSIGNMENT OF REGISTERED MARK 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:

The above named owner of the mark (the Assignor), hereby assigns to the Assignee and new owner named below, all rights, title and interest to and in mark, together with the good will of the business symbolized by the mark, along with the registration thereof.

4. Name of Assignee: 5. Address of Assignee: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

6. State of Formation of the Assignee if other than a natural person:

EXECUTION:
We, the assignor and the assignee, hereby declare under the penalties of false statement that the statements made in the foregoing assignment are true.

7. ___________ Date

8. _________________________________ Name of Signatory for Assignor

9. _________________________ Title of Signatory if applicable

10. _________________________________________________________________ Signature

11. ___________ Date

12. _______________________________ Name of Signatory for Assignee

13. ______________________ Title of Signatory if applicable

14. ________________________________________________________________ Signature 15. The assignor must submit three specimens or photographs of the mark as actually used in this state.
Rev. 08/24/2007