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State of Missouri
Assignment of Mark Registration
Whereas ______________________________________________________________________
(name of assignor)
of ___________________________________________________________________________
(address)
has adopted, used and is using a mark which is registered in the State of Missouri, Registration
No. ____________, dated ____________________________________________________; and
Whereas ______________________________________________________________________
(name of assignee)
of ___________________________________________________________________________
(address)
is desirous of acquiring said mark and the registration thereof;
Now, therefore, for good and valuable consideration, receipt of which is hereby
acknowledged, said _____________________________________________________________
(name of assignor)
does hereby assign unto the said ___________________________________________________
(name of assignee)
all right, title and interest in and to the said mark, together with the good will of the business
symbolized by the mark, and the above identified registration thereof.
_________________________________________
(signature of assignors if assignor is a corporation or other
juristic organization, give the official title of the person
who signs for assignors)
State of ____________
County of __________
On this ___________ day of _______________, before me appeared _________________. The
person who signed this instrument, who acknowledged that he/she signed it as a free act on
his/her own behalf (or on behalf of the identified corporation or other juristic entity with author-
ity to do so).
_________________________________________
Return completed form to:
(signature of notary public)
Typed or printed name ______________________
Corporations Division
State of __________________________________
PO Box 778
Commissioned for ____________________ County
Jefferson City, MO 65102
My commission expires _____________________
(573) 751-3200
TMSM 30 (10-07)