Free Registrant Name or Address Amendment - Massachusetts

RNA

Filing Fee $50.00

AMEND

The Commonwealth of Massachusetts
William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512

FORM MUST BE TYPED

Registrant Name or Address Amendment
(General Laws Chapter 110H, Section 7)

FORM MUST BE TYPED

All information must be completed or this document will not be accepted for filing. (1) Applicant's legal name and business address: or b) Business Organization: _____________________________________________________________________________ Business address: _________________________________________________________________________________ Number Street _________________________________________________________________________________ City State Zip a) Individual: ______________________________________________________________________________________ Last First Middle Business address: _________________________________________________________________________________ Number Street _________________________________________________________________________________ City State Zip



(2) The mark is (complete one of the following): a) Words only - If the mark is only words, the words in the mark are (include type style if it is claimed as part of the mark):

b) Design Only - If the mark is a design only, describe the design (include colors if they are claimed as part of the mark):

c) Words and Design - State the words in the mark (include color and type style if they are claimed as part of the mark) and describe the design:

c110hs7amend 10/26/06

(3) For each class provide the number and class in which such goods or services fall (see attached classification schedule):

(4) Provide the Massachusetts registration date and number:

(5) Registrant's name has been changed to: a) Individual: ______________________________________________________________________________________ Last First Middle or b) Business Organization: _____________________________________________________________________________

(6) Registrant's business address has been changed to: _______________________________________________________________________________________________ Number Street _______________________________________________________________________________________________ City State Zip

I, ________________________________________________________________________________________ , state that I am the registrant or a lawfully authorized representative of the registrant and declare under penalty of perjury that the foregoing application is true and correct. Executed on: _________________________________________________________________________________________ Month Day Year Signature: ____________________________________________________________________________________________

COMMONWEALTH OF MASSACHUSETTS
Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512

William Francis Galvin

Registrant Name or Address Amendment
(General Laws Chapter 110H, Section 7)
Registered with

WILLIAM FRANCIS GALVIN
SecretaryoftheCommonwealth on: ___________________________________________ , 20 _________________ Trademark Section One Ashburton Place, Rm. 1717 Boston, MA 02108 Contact Information ________________________________________________________________ Name ________________________________________________________________ MailingAddress ________________________________________________________________ City/town State ZIP ________________________________________________________________ Telephone Email