Form Dos 247-F-L-A - Application For Renewal Of Trademark/service Mark

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NYS DEPARTMENT OF STATE
REG NO.
DIVISION OF CORPORATIONS, STATE RECORDS AND UNIFORM COMMERCIAL CODE
One Commerce Plaza, 99 Washington Avenue
Albany, NY 12231-0001
Application for Renewal of Trademark/Service Mark
This application must be accompanied by a specimen showing actual use of the mark and the $50 filing fee.
1. APPLICANT NAME
2. ADDRESS
NUMBER AND STREET
CITY
STATE
ZIP
3. NAME OR DESCRIPTION OF MARK TO BE RENEWED PURSUANT TO ARTICLE 24 OF THE GENERAL BUSINESS LAW
TRADEMARK
6. SPECIFY TYPE OF MARK
5. ORIGINAL REGISTRATION NUMBER
4. DATE THE MARK WAS REGISTERED WITH THE
BEING RENEWED
SECRETARY OF STATE OF THE STATE OF NEW YORK
SERVICE MARK
The above-referenced mark has been and still is in use.
X
(Signature of Applicant)
>
State of New York
ss:
County of
I,
,
being duly sworn, depose and state that I am the person described in the
foregoing application and that I have read the foregoing application and know the
contents thereof to be true, except as to the matters therein stated to be alleged
upon information and belief, and as to those matters, I believe them to be true.
FOR OFFICE USE ONLY
(Name of Signer)
(Title of Signer)
Sworn to before me this
day
of
, 20
.
X
(Notary Public)
Page 1 of 1
DOS-0247-f-l-a (Rev. 07/11)

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