State of California
Secretary of State
APPLICATION TO REGISTER DESCRIPTION OF BRAND
Pursuant to Business and Professions Code Section 14427
IMPORTANT Read instructions before completing this form.
APPLICATION FOR: RETURNABLE CONTAINERS EQUIPMENT/SUPPLIES
1. REGISTRANT NAME 2. BUSINESS ADDRESS
CITY STATE ZIP CODE
3. BUSINESS STRUCTURE (Check One)
CORPORATION (State of Incorporation)_____________________________ LIMITED LIABILITY COMPANY (State of Organization) ____________________________ LIMITED PARTNERSHIP (State of Organization) ____________________________ GENERAL PARTNERSHIP (State of Organization) _________________________________ 4. LIST NAMES OF PARTNERS, IF REGISTRANT IS A LIMITED OR GENERAL PARTNERSHIP SOLE PROPRIETOR
SPOUSES, AS COMMUNITY PROPERTY
DOMESTIC PARTNERS, AS COMMUNITY PROPERTY OTHER (Describe) ____________________________________
5. LIST NAMES OF MEMBER(S) OR MANAGER(S), IF REGISTRANT IS
A LIMITED LIABILITY COMPANY
6. DESCRIPTION OF NAME, MARK OR DEVICE (DESIGN) IMPRESSED OR PRODUCED ON RETURNABLE CONTAINERS:
LIST SPECIFIC KINDS OF PRODUCTS THAT ARE MANUFACTURED, PACKED, CANNED, BOTTLED AND SOLD: LIST SPECIFIC KINDS OF RETURNABLE CONTAINERS ON WHICH BRAND APPEARS:
7. DESCRIPTION OF NAME, MARK OR DEVICE (DESIGN) IMPRESSED OR PRODUCED ON EQUIPMENT/SUPPLIES: LIST SPECIFIC KINDS OF EQUIPMENT/SUPPLIES ON WHICH BRAND APPEARS:
8. NAME OF CORPORATION, LIMITED LIABILITY COMPANY, OR LIMITED OR GENERAL PARTNERSHIP (If Applicable)
SIGNATURE OF AUTHORIZED PERSON 10. RETURN ACKNOWLEDGMENT TO: (Type or Print)
TYPE OR PRINT NAME AND TITLE THIS SPACE FOR FILING OFFICER USE CONTAINER BRAND CERT. NO. ________________________
NAME ADDRESS CITY/STATE/ZIP
SEC/STATE TM/CB 100/101(REV 05/09)
FILING FEE: $30.00
INSTRUCTIONS FOR COMPLETING APPLICATION TO REGISTER DESCRIPTION OF BRAND ON RETURNABLE CONTAINERS OR EQUIPMENT/SUPPLIES
Type or print in blue or black ink. Mail your application with original signature and $30.00 filing fee to the Secretary of State, Trademark Unit, P.O. Box 942877, Sacramento, CA 94277-0001. Please indicate at the top of the application which type of Description of Brand is being filed.
Item 1. Enter the complete name of the registrant.
Item 2. Enter the complete business address of the registrant. Item 3. Identify the business structure of the registrant by checking the appropriate box. If a corporation, limited liability company, limited partnership or general partnership, list the state of origination. Item 4. Enter the names of the general partners, if registrant is a limited or general partnership. Attach additional pages, if necessary. Item 5. Enter the names of the member(s) or manager(s) if registrant is a limited liability company. Attach additional pages, if necessary. Item 6. For Returnable Containers, enter the description of the mark, name, or device (design). List specific kinds of products (such as olives, beer, milk, etc.) that are manufactured, packed, canned, bottled and sold. List specific kinds of returnable containers (such as bottles, boxes, kegs, etc.) on which brand appears. Item 7. For Equipment/Supplies, enter the description of the mark, name, or device (design). List specific equipment/supplies (such as shopping carts, horse trailers, etc.) on which brand appears. Item 8. Enter the name of the corporation, limited liability company, or limited or general partnership (if applicable). Item 9. Date, sign, and print the name of the authorized person signing the application. If the registrant is a corporation, limited liability company, or limited or general partnership, please list the title of the person signing the application on behalf of the entity. Item 10. Enter the name and address of the person or firm to receive the acknowledgment of the filing.