Form Pto-1594 (Rev. 6-12) - Recordation Form Cover Sheet
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3U.S. DEPART M E N T OF CO MM ERCE
Form PTO-1594 ( Rev . 6-12 )
United States Patent and Trademark Off i ce
O M B Collection 0651-0027 (exp. 04/30/2018)
RECORD A TION FO RM C O VER SHEET
TR A DEM A RKS ONLY
To the Director of the U. S. Patent and Trademark O ff i ce: Please record the attached documents or t h e new address(es) belo w .
1. Na m e of c on v e y ing part y
ies):
2. Na m e and addr e ss of rec e i v ing part y (ies)
(
Yes
Additional names, addresses, or citizenship attached?
No
Name : __ _ __ _ __ _ __ _ __ _ __ __ ___ _ __ _ __ _ __ _ __ _ __ _ __
: _ _____ _ ___ _ _______ _ _____ _ _____
Street A ddr e ss
Ass o c i ati o n
Indi v i d ual ( s)
Li m ite d Part n er s hi p
Part n er s hip
Cit y :
__ ___________________________________ __ _ _
Corpora t ion- Sta t e: _ _ __ _ __ __ ___ _ __ _ __ _ __ _ ___
State :
__ _ __ _ __ _ __ _ __ _ __ __ ___ _ __ _ __ _ __ _ _ __ __ _ __
Other
____ _ _____ _ _____ _ _______ _ _____ _ __
Countr y : _ _ __ _ __ _ __ _ __ _ __ _ ___ _ Zip : __ _ __ _ __ _ ___ _ __
Citi z en s hip (s e e g ui d el i nes ) _ _ ___ _ __ _ __ _ __ _ __ _ __ _ __
Individual(s) Citizenship
__________________________
Additional names of conveying parties attached?
Yes
No
Association
__________________________
Citizenship
____________________
Partnership
Citizenship
3. Nature of con v e y ance/Execution Date(s) :
Citizenship ____________________
L i mited Partnership
E x ecution Da t e(s ) __ _ __ _ __ __ ___ _ __ _ __ _ __ _ __ _ __ _ __
Corporation Citizenship____________________________
Ass i g n ment
M erger
Other____________
Citizenship ___________________
Secu r ity Agre e m e nt
Chan g e of N ame
If assignee is not dom i c i led in the United States, a domestic
Yes
No
representative designation is attached:
Other_ _ __ _ __ _ __ _ __ _ __ _ __ _ ___ _ __ _ __ _ __ _ __ _ _
(Designations must be a separate document fr o m a ssignment)
4. A pplication num b er(s) or registrati o n nu m ber(s) and i dentifi c ation or de s cription of the Tr a de m ark.
Text
B. T
adema r k R e gi s trat i on N o.
s)
r
(
A. T radema r k A p pl i ca t ion No. ( s)
Additional sheet(s) attached?
Yes
No
C. Ide n tif i ca t ion or D e sc r ipt i on of T rade m ark ( s) ( a nd F il i ng D a te if A pp l i c ati o n or R eg i stra t ion Num b er i s u n k n o w n):
5. Na m e & add r ess of party to wh o m corr e spon d en c e
6. Tot a l nu m ber of appl i cati o ns and
concer n ing d o cu m ent s h ou l d be m ail e d:
registrati o ns in v ol v ed:
Name : __ _ __ _ __ _ __ _ __ _ __ __ ___ _ __ _ __ _ __ _ __ _ __ _ __
Inter n al A ddr e ss : __ _ __ _ __ __ ___ _ __ _ __ _ __ _ __ _ __ _ ___
7. Tot a l fee (37 CFR 2.6 ( b)(6) & 3. 4 1)
$____________
Autho r i z ed to be c h arg e d to d ep o sit a c co u nt
Street A ddr e ss:
Enc l os e d
8. Pa y ment Information:
Cit y : ___ _ __ _ __ _ __ _ __ _ __ __ ___ _ __ _ __ _ __ _ __ _ __ _ ___
Zip: _ __ _ __ _ __ _ __ _ ___
State : __ _ __ _ __ _ __ _ __ _ __ __ _
Phone Nu m ber: __ _ __ _ __ _ _ _ ___ _ __ _ __ _ __ _ __ _ __ _ ___
De p os i t A c co u nt N u mber _ _ ___ _ __ _ __ _ __ _ __ _ ___
Docket Number: _ __ _ __ _ __ _ __ _ ___ _ __ _ __ _ __ _ __ _ __ _ _
Autho r i z ed U s er Na m e _ __ __ ___ _ __ _ __ _ __ _ __ _ __
Ema i l Add r e s s: __ _ __ _ __ _ _ _ ___ _ __ _ __ _ __ _ __ _ __ _ ___
9. Sig n ature:
Sign a ture
Date
T otal nu m b e r of p ages i nc l ud i ng co ve r
she e t, at tach m e n ts, a nd do c u m e nt :
Name of Pe r son Si g ni n g
D ocu me n t s t o be r eco r d e d ( in c l ud i n g co v er s he et ) s h o u ld be f a xed to (5 71 ) 27 3 -0140, or m a i l e d to:
M a i l S top As s i g n me nt R e c o r d at i o n Branch , D i r e c tor o f the USP T O , P . O . B ox 1 45 0 , A le x a n d r i a , V A 2 2 31 3 -1 45 0
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