Free Trademark or Servicemark Application for Change of Name and/or Address of Registrant - Illinois


File Size: 173.8 kB
Pages: 2
Date: November 21, 2008
File Format: PDF
State: Illinois
Category: Trademark
Word Count: 376 Words, 2,990 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.cyberdriveillinois.com/publications/pdf_publications/tmsm35b.pdf

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Preview Trademark or Servicemark Application for Change of Name and/or Address of Registrant
State of Illinois Trademark or Servicemark
Application for Change of Name and/or Address of Registrant TM/SM-35b
Mailing Address:
Secretary of State Department of Business Services Trademark Division Rm. 330 Howlett Building Springfield, IL 62756 217-524-0400 www.cyberdriveillinois.com Application must be typed or legibly printed in black ink. Name/address changes must be on form provided by the Secretary of State. A $5 recording fee is required in the form of a check or money order payable to Illinois Secretary of State. See instruction page for additional information.

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This space for use by Secretary of State.

1. Name of Registrant/Owner of Mark: _________________________________________________________________ 2. Mailing Address: _________________________________________________________________________________
Street

______________________________________________________________________________________________
City, State, ZIP Code

3. Registration Number:

-------------

Original Date of Registration: ____________________________

4. Name of Mark: __________________________________________________________________________________

5. Name of Registrant/Owner of Mark: __________________________________________________________________ and/or 6. Mailing Address: _________________________________________________________________________________
Street

______________________________________________________________________________________________
City, State, ZIP Code

The undersigned hereby declares, under penalties of perjury, that the statements contained in the foregoing application are true.
X
Signature of Applicant Name of Applicant (type or print)

Official Capacity

Contact Phone Number

Printed by authority of the State of Illinois. November 2008 1 C 293.5

Instructions for Completing Name/Address Change Application
1. Provide the name of registrant/owner of mark as it currently appears on the records of the Secretary of State's office. 2. Provide the complete address as it currently appears on the records of the Secretary of State's office. 3. Provide the registration number and original date of registration as it currently appears on the records of the Secretary of State's office. 4. Provide the name of the mark as originally registered. 5. Provide the name of the registrant as it should appear after the recording of this document. 6. Provide the address of the registrant as it should appear after the recording of this document. Signature and Contact Information The registrant or the attorney-in-fact for the registrant must sign the form. The capacity in which the person is signing must be provided (i.e., registrant, officer, attorney-in-fact). Photocopied, stamped or faxed signatures are unacceptable. Duration A certificate indicating the change in name and/or address may be issued for the remainder of the current term of the mark.

Printed by authority of the State of Illinois. November 2008 1 C 293.5