JAY DARDENNE SECRETARY OF STATE
STATE OF LOUISIANA SECRETARY OF STATE
Commercial (225) 925-4704 (225) 922-0435 Fax Administrative Services (225) 925-4704 (225) 925-4726 Fax Uniform Commercial Code (225) 922-1193 (225) 922-0452 Fax
TRANSMITTAL INFORMATION For All Business Filings
Business Name (List exactly as it appears in documents)
Name of person filing document (evidence of filing will be mailed to this person, at address below)
Daytime phone number
NOTE: Louisiana Law requires all Louisiana notaries to print or type their name and notary or bar roll number on the document.
Mailing Address: P. O. Box 94125, Baton Rouge, LA * 70804-9125 Office Location: 8585 Archives Ave., Baton Rouge, LA * 70809 Web Site Address: www.sos.louisiana.gov
SS984 Rev. 10/08
Jay Dardenne Secretary of State
APPLICATION TO REGISTER TRADE NAME TRADEMARK OR SERVICE MARK
(Pursuant to R.S. Of 1950, Title 51, Chapter 1, Part VI as amended) Enclose $50 filing fee Make remittance payable to Secretary of State Do Not Send Cash Return to: Commercial Division P. O. Box 94125 Baton Rouge, LA 70804-9125 Phone (225) 925-4704 Web Site: www.sos.louisiana.gov
STATE OF PARISH/COUNTY OF Check One: Check One: ( ) Trade Name ( ) Trademark ( ) Service Mark
( ) Original Filing ( ) Renewal
1. Name of person(s), Corporation, Limited Liability Company or Partnership applying for registration:
2. If applicant is a corporation, list state of incorporation:
3. Full street address and P. O. Box address, city, state, and zip of applicant: 4. Name of trade name, trademark or service mark to be registered. If logo is included, please describe. If the LOGO of your trade name, trademark or service mark is part of your registration, attach 2 copies of design.
5. Type of business or list of goods or services to which the trade name, trademark or service mark is applied:
6. Enter class(es) in which trademark or service mark is registered:
(Class list on reverse side. There is a $50 registration fee for each class number registered.)
7. Date trade name, trademark or service mark first used by applicant Month, Day, Year 8. Date trade name, trademark or service mark first used in Louisiana Month, Day, Year I, the applicant, am the owner of the trade name, trademark or service mark sought to be registered and no other person, firm, association, union or corporation has the right to such use in such class, either in the identical form hereinabove described, or in any such resemblance thereto as may be calculated to deceive, and the facsimiles or counterparts herein filed are true and correct. Sworn to and subscribed before me, the undersigned Notary Public, on this date: The below named person swears that he is the applicant, or an authorized representative of the applicant, named in the foregoing application, and that the facts alleged in said application are true. NOTARY NAME MUST BE TYPED OR PRINTED WITH NOTARY # Applicant or Authorized Representative Notary Signature
SS309 Rev. 03/08
(see instructions on back)
1. Trade Name - a word or group of words, name, symbol, device or any combination thereof used by a person to identify his business, vocation or occupation and distinguish it from the business, vocation or occupation of others. Trademark - any word, name, symbol, device or any combination thereof adopted and used by a person to identify goods, made or sold, and to distinguish them from goods made or sold by others. Service Mark - a mark used in the sale or advertising of services to identify the services of one person and distinguish them from the services of others. 2. Fill in the full name of the individual(s), corporation, partnership or limited liability company who is the owner of the trade name, trademark or service mark being registered. 3. Give full municipal and mailing address of the person(s) listed in No. 2. 4. List the trade name, trademark or service mark exactly as you intend to use it in your business. If a logo is included, please describe. 5. Describe the type of business, such as "restaurant" or "retail grocery store" etc. If you are registering a trademark or service mark, list goods or services to which the name is applied, such as "cosmetics", "baker goods", "fishing equipment", etc. 6. No. 6 applies only to trademarks and service marks. Write the class number(s) under item 6. Check the list of classes set out below which describe the category of goods (trademarks only) or services (service marks only) being registered. If goods or services are registered in more than one class, you must pay a registration fee of $50 for each class registered. 7. List the month, day and year when you first started using the trade name, trademark or service mark in business. 8. List the month, day and year when you first started using the trade name, trademark or service mark in Louisiana. The trade name, trademark or service mark must actually be in use on the date of this application. If you have not started actual use of the trade name, trademark or service mark, you can reserve the trade name, trademark or service mark for 60 days by sending a letter and $25 fee to the Secretary of State asking that it be reserved. 9. The affidavit must be notarized. Show the name of the applicant, the name of the person authorized to make the application and his title. The application must be signed by the applicant or the designated authorized representative.
NOTE: The certificate of registration shall be issued if the Secretary of State finds that the trade name is distinguishable from or not the same as a trade name, limited liability company name, or corporate name already in use in this state, or that the trademark or service mark is distinguishable from or not the same as a trademark or service mark already in use in this state which is registered in the same class.
The said classes are as follows:
A. Goods (Trade Marks) 1. Chemicals 2. Paints 3. Cosmetics & cleaning preparations 4. Lubricants & fuels 5. Pharmaceuticals 6. Metal goods 7. Machinery 8. Hand tools 9. Electrical & scientific apparatus 10. Medical apparatus 11. Environmental control apparatus 12. Vehicles 13. Firearms 14. Jewelry 15. Musical instruments
16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30.
Paper goods & printed matter Rubber goods Leather goods Nonmetallic building materials Furniture & articles not otherwise classified House wares & glass Cordage & fibers Yarns & threads Fabrics Clothing Fancy goods Floor coverings Toys & sporting goods Meats & processed foods Staple foods
31. 32. 33. 34. 35. B. 35. 36. 37. 38. 39. 40. 41. 42.
Natural agricultural products Light beverages Wines and spirits Smokers' articles Miscellaneous Services (Service Marks) Advertising and business Insurance & financial Construction & repair Communication Transportation & storage Material treatment Education & entertainment Miscellaneous