Mark:                     ______________

                              Mark in all Caps

Int’l Class No(s).:    ______________

Applicant:______________________________________

A Corporation of the State of _______________________

Business Address:   ______________________________

                                 ______________________________

                                 ______________________________

Applicant requests registration of the mark illustrated in the accompanying drawing in the United States Patent and Trademark Office on the Principal Register established by the Act of July 5, 1946 (15 USC § 1051 et seq., as amended) for the following goods and/or services: ____________________ ____________________________________________________________________________________ (list goods/services for each class, in class number order) in International Class _________________.   Applicant has a bona fide intention to use the mark in commerce on or in connection with the above-identified goods and services.  Applicant intends to use the mark by affixing the mark to labels which are attached to the goods, affixing the mark to the packaging of the goods, or affixing the mark directly to the goods.

Applicant is the owner of Registration No(s).  ___________________________________

The undersigned, being warned that willful false statements and the like, so made, are punishable by fine or imprisonment, or both, under Section 1001 of Title 18 of the United States Code and that such willful false statements may jeopardize the validity of the application or any registration resulting therefrom, declares that:  I am _________________________________ (Title of Applicant), and am authorized to execute this instrument on behalf of the Applicant.  I believe the Applicant to be the owner of the mark sought to be registered.  To the best of my knowledge and belief, no other person, firm, corporation, or association has the right to use such mark in commerce, either in the identical form or in such near resemblance thereto as to be likely, when used on or in connection with the goods or services of such other person, to cause confusion, or to cause mistake, or to deceive; and all statements made on my knowledge are true and all statements made on information and belief are believed to be true.  Applicant appoints ____________________________________________________ ________________________________________________________ (List Attorneys’ Names) of the Bar of the State of ____________________________________________, whose addresses are ___________________________________________________________________________________, telephone number (___)_____________, to prosecute this application to register, to transact all business in the Patent and Trademark Office in connection therewith, and to receive the Certificate of Registration.                             

This is not a substitute for legal advice.  An attorney must be consulted.
Copyright ©1994 - 2009 by LAWCHEK, LTD.