State of South Dakota Mark Registration Application
SDCL 37-6-5
Clear Form
FILING FEE: $125 payable to SECRETARY OF STATE
HELP
Attach two samples or facsimiles of the Mark, no larger than 8 1/2" x 11"
1. Applicant: ____________________________________________________________________________________ Address: ___________________________________________ City: ____________________________________ County: ___________________________________ State: __________________ Zip: _____________________ Business Telephone Number: ______________________________ 2. If a Corporation, where incorporated: _______________________________________________________________ 3. If a partnership, list name and address of partner(s): _______________________________________________________________________________________________
Partner Address City State ZIP
_______________________________________________________________________________________________
Partner Address City State ZIP
_______________________________________________________________________________________________
Partner Address City State ZIP
4. Name of Mark:
5. Description of goods or services connected with Mark:
6. Mode or manner in which the Mark is used:
7. Classification of Goods or Services Number: __________________ 8. Date the Mark was first used by Applicant or Predecessor: a. In the United States: _________________________________________ b. In the State of South Dakota: ___________________________________
Trademark Application 07/01/2009 Page 1 of 2
*** This section is to be completed in the presence of a Notary Public ***
State of _________________________ ) )ยงยง County of ________________________ )
I, ___________________________________________________ , __________________________________________ (Print Name of Applicant) (Title) of ______________________________________________________________________________________________ (Print Corporation-Partnership-Association) do solemnly swear that the above named applicant is the owner of the Mark and that no other person has the right to use such Mark in the State of South Dakota either in the identical form thereof or in such near resemblance thereto as might be calculated to deceive or to be mistaken therefor.
By: ___________________________________________ (Applicant Signature)
Subscribed and sworn to before me this _______ day of ________________________ , 20 _______ .
_________________________________ My Commission Expires
______________________________________________ Notary Public
(Notarial Seal)
Return to: SECRETARY OF STATE 500 East Capitol Pierre, SD 57501 (605) 773-3539
Trademark Application 07/01/2009
Page 2 of 2