Filing Fee: $20.00
ID No. ___________
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Office of the Secretary of State
Corporations Division
Trademark Section
148 W. River Street
Providence, Rhode Island 02904-2615
ASSIGNMENT OF A TRADEMARK OR SERVICE MARK
TO BE TYPED-PLEASE READ INSTRUCTIONS BEFORE COMPLETING THIS FORM
WHEREAS:
1. Name of Present Owner _________________________________________________________________________________________________
2. (a) Principal business address ____________________________________________________________________________________________
Street
_____________________________________________________________________________________________________________________
City/Town
State
Zip Code
(b) Business address in Rhode Island, if any. (To be filled in only if principal business address is not in Rhode Island.)
_____________________________________________________________________________________________________________________
Street
City/Town
State
Zip Code
3. State whether present owner is an individual, partnership, corporation, union or association: ___________________________________________
4. If a corporation, what is the state of incorporation? ___________________________________________________________________________
5. Has adopted and used the ________________________________________________________________________________________________
(trademark or service mark)
which is registered under No. _____________________________, as of _________________________________, _________, in the office of the
Secretary of State of Rhode Island
NOW, THEREFORE, to all to whom it may concern:
Be it known that for good and valuable consideration, the receipt of which is hereby acknowledged, said owner has sold, assigned and transferred the
registered mark, and by these presents does sell, assign and transfer unto:
6. Name of New Owner ___________________________________________________________________________________________________
7. (a) Principal business address ____________________________________________________________________________________________
Street
_____________________________________________________________________________________________________________________
City/Town
State
Zip Code
(b) Business address in Rhode Island, if any. (To be filled in only if principal business address is not in Rhode Island.)
8. State whether present owner is an individual, partnership, corporation, union or association: ___________________________________________
9. If a corporation, what is the state of incorporation? ____________________________________________________________________________
10. The entire right, title and interest in and to __________________________________________________________________________________
(Indicate the mark)
and the registration thereof, together with the good will of the business in connection with which the said mark is used.
_____________________________________________________________
Name of Prior Owner
_____________________________________________________________
Signature of Prior Owner or Authorized Representative of Prior Owner
_____________________________________________________________
Title
STATE OF _________________________
COUNTY OF _______________________
In __________________________________, on this _________ day of ___________________________, 20___, personally appeared
before me _________________________________________________________________, who, being by me first duly sworn, declared that he/she
signed the foregoing assignment in the capacity indicated and that, being informed of the contents of the assignment, he/she executed the same
voluntarily.
_____________________________________________________________
Notary Public
My commission expires: _________________________________________
Form No. T-83
Revised: 12/05