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SAMPLE FORM

IN THE UNITED STATES PATENT AND TRADEMARK OFFICE

APPLICATION

FOR REGISTRATION OF MARK

ON THE PRINCIPAL REGISTER

Trademark Act of July 5, 1946

William Cox¹

Applicant’s Name

Attorney Docket No. 30²

File No. 15³

Comprising:

Statement

Declaration and Power of Attorney

Three Specimens or Facsimiles

Drawing

Filing Fee ($245.00)

Filed by:

Miser & Miser Law⁴

Name Of Law Firm

Address: Corvette Ave. NE⁵

Little Town, MN

55416

Telephone: 612-450-6100⁵

Mark: >_/> ⁶

Mark in all Caps

Int’l Class No(s).: 51 ⁷

Goods: AUDIO TAPES AND BOOKS⁸

Description of Goods/Services in all Caps

This is not a substitute for legal advice. An attorney must be consulted.
Copyright ©1994 - 2024 by LAWCHEK, LTD.

IN THE UNITED STATES PATENT AND TRADEMARK OFFICE

APPLICATION FOR REGISTRATION OF MARK

PRINCIPAL REGISTER

Mark: >/> ⁹

Mark in all Caps

Int’l Class No(s).: 51 ¹⁰

Applicant: William Cox Co.¹¹

A Corporation of the State of Minnesota¹²

Business Address: 15 1st Ave.

St. Paul, MN 55101¹³

______________________________

STATEMENT

Applicant has adopted and is using the mark in commerce as shown in the accompanying drawing

for the following goods and/or services: AUDIO TAPES & BOOKS¹⁴

Description of Goods/Services in all Caps

in International Class(es) to be assigned¹⁵ and requests that said mark be registered 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).

The mark was first used on or in connection with the [x]¹⁶ goods [ ] services on or about

8/1/95¹⁷ , was first used in interstate commerce on or about

First Date of Use

8/30/95¹⁸ , and is now in use in such commerce.

First Date of Use

The mark is used by applying it to: [x] the goods¹⁹

[x] labels which are affixed to the goods

[ ] packages in which the goods are sold

[x] literature accompanying the goods

[ ] point-of-sale display material for the goods

                                                            [x] promotional material related to the services and uttering it
                                                                 in the course of rendering the services and in other ways
                                                                 customary in the trade; and
                                                            [ ] three specimens
                                                            [x]²⁰ facsimiles showing the mark as used in commerce are
                                                                    enclosed with this application.

(Check all that apply and repeat for each class.)

This is not a substitute for legal advice. An attorney must be consulted.
Copyright ©1994 - 2024 by LAWCHEK, LTD.

Applicant is the owner of Registration No(s). 50²¹

DECLARATION AND POWER OF ATTORNEY

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 President²² (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 Philip Miser, Charles Miser²³

List Attorneys’ Names

of the Bar of the State of Minnesota²⁴ , whose addresses are

Corvette Ave. NE, Little Town, MN 55416²⁵

_______________________________________, telephone number (612) 889-7765²⁶ , 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.

Please correspond with:

Phillip Miser, Attorney²⁷

Corvette Ave. NE

Little Town, MN 55416

William Cox²⁸

Applicant’s Name

By:_____________________________________²⁹ Date: 9/5/95³¹

Signature

William Cox, President ³⁰

Name and Title

This is not a substitute for legal advice. An attorney must be consulted.
Copyright ©1994 - 2024 by LAWCHEK, LTD.

Name of Applicant: William Cox³²

Address: 15 1st Ave.

St. Paul, MN 55101

For: Trademark³³

Place Drawing or Typed Mark here

™ ³⁴

The above is an example of how a typical Use-Based Trademark Application form may be completed.

1. The full name of the applicant.

2. The docket number is assigned by the attorney.

3. The file number is assigned by the attorney.

4. The full name of the law firm handling the application.

5. The full address and telephone number of the law firm.

6. The trademark for which this application is being filed.

7. This number is assigned by the Patent Office.

8. A description of the goods and/or services associated with the trademark in capital letters.

9. The trademark for which this application is being filed.

10. This number is assigned by the Patent Office.

11. The full name of the applicant.

12. The state in which the corporation is located.

13. The full address of the corporation.

14. The goods and/or services associated with the trademark.

15. This number is assigned.

16. Indicate whether the trademark was first used with goods or services.

17. The date on which the trademark was first used.

18. The date on which the trademark was first used in interstate commerce.

19. Check all that apply that are used with the trademark.

20. Indicate whether specimens or facsimiles are enclosed.

21. This number is assigned by the Patent Office.

22. The title of the applicant.

23. The full name of the attorneys handling this application.

24. The state in which the attorneys practice.

25. The full address where the attorneys practice.

26. The telephone number of the attorneys.

27. The full name and address of the person to receive the trademark information.

28. The printed name of the applicant.

29. The signature of the applicant.

30. The typed name and title of the applicant.

31. The date on which the document is signed.

32. The full name and address of the applicant.

33. The purpose of this document.

34. A copy or drawing of the mark to be used.

This is not a substitute for legal advice. An attorney must be consulted.