Free TMC.pmd - Kansas

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

Trademark or Service Mark Cancellation/Termination Form
All information must be completed or this document will not be accepted for filing.

TMC
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 State Zip

5. Expiration Date:
Month Day Year

The above does herby cancel/terminate said trademark or service mark for the following reason:

Signature of current owner

Date

Phone number

Instruction Submit this application with the $15 filing fee. Please send a separate form for each additional assignment. Notice: The is a $25 service fee for all returned checks.
Rev.1/9/09 jls K.S.A.81-208