Free TMA - Kansas

Our fees increased September 1, 2003. Please review the instruction box on the form for the new fee. Contact Information
Kansas Secretary of State Ron Thornburgh Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594 (785) 296-4564 [email protected] www.kssos.org

KANSAS SECRETARY OF STATE

Trade-Mark or Service-Mark Assignment Form
All information must be completed or this document will not be accepted for filing.

TMA
58

Print

Reset

Please complete the form, print, sign and mail to the Kansas Secretary of State with the filing fee. Selecting 'Print' will print the form and 'Reset' will clear the entire form.
Do not write in this space

1. Trademark or Service-mark: 2. Classification: 3. Current owner: 4. Address:
Street address City Day Year State Zip

5. Expiration date:
Month

The above does hereby assign said trademark or service-mark to the following: 6. New owner: 7. Address:
Street address City State Zip

Signature of current owner

Instruction Submit this application with the $15 filing fee. Please send a separate form for each additional assignment. Notice: There is a $25 service fee for all returned checks.

Rev. 8/11/03 jb

K.S.A. 81-208