State of California
Secretary of State
APPLICATION TO REGISTER NAME OF FARM, RANCH, ESTATE OR VILLA
Pursuant to Business and Professions Code section 14460
IMPORTANT Read instructions before completing this form.
CHECK ONE BOX: FARM RANCH ESTATE VILLA
1. NAME OF FARM, RANCH, ESTATE, OR VILLA 2. COUNTY OF 3. LOCATED AT
CITY STATE ZIP CODE
4. REGISTRANT (OWNER AND/OR LESSEE)
5. IF MORE THAN ONE OWNER: RELATIONSHIP OF OWNERS AND/OR LESSEES, AS PARTNERS, JOINT TENANTS, TENANTS -IN COMMON, SPOUSES AS COMMUNITY PROPERTY, OR DOMESTIC PARTNERS AS COMMUNITY PROPERTY, ETC.
6. THE UNDERSIGNED CERTIFIES THAT THE ABOVE INFORMATION IS CORRECT AND THAT TO THE BEST OF HIS/HER/THEIR KNOWLEDGE NO OTHER PERSON HAS, PREVIOUS TO REGISTRANT, ADOPTED OR USED SAID NAME AS A FARM, RANCH, ESTATE OR VILLA NAME IN THE STATE OF CALIFORNIA.
SIGNATURE OF OWNER, LESSEE
SIGNATURE OF PARTNER, SPOUSE, ETC.
7. RETURN ACKNOWLEDGMENT TO: (Type or Print)
THIS SPACE FOR FILING OFFICER USE FARM, RANCH, ESTATE, OR VILLA REG. NO.__________________________
NAME ADDRESS CITY/STATE/ZIP
SEC/STATE TM/FN 103 (REV 05/09)
FILING FEE: $10.00
INSTRUCTIONS FOR COMPLETING APPLICATION TO REGISTER NAME OF FARM, RANCH, ESTATE OR VILLA
Type or print in blue or black ink. Mail your application with original signature and $10.00 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 registration you are filing.
Item 1. Item 2. Item 3. Item 4.
Enter the complete name of the farm, ranch, estate or villa. Enter the county where the farm, ranch, estate or villa is located. Enter the complete address of the farm, ranch, estate or villa. Enter the complete name of the registrant (owner and/or lessee) of the farm, ranch, estate or villa. Enter the relationship of the registrants (owners and/or lessees), if there is more than one owner of the farm, ranch, estate or villa. Date and sign the registration. If there is more than one owner and/or lessee of the farm, ranch, estate or villa, the partner(s) or spouse is required to sign. Enter the name and address of the person or firm to receive the acknowledgment of the filing.