Form T-3 - Application For Registration Of Service Mark 2008

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FORM T-3

WWW.

USINESS

7/2008

Nonrefundable Filing Fee: $50.00

STATE OF HAWAII

DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS

Business Registration Division

*T3*

Clear Info

335 Merchant Street

Mailing Address: P.O. Box 40, Honolulu, Hawaii 96810

Phone No. (808) 586-2727

APPLICATION FOR REGISTRATION OF SERVICE MARK

(Chapter 482, Hawaii Revised Statutes)

PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK

Applicant’s Name:______________________________________________________________________________________________________

Business Address: ____________________________________________________________________________________________________

(including city, state, and zip code)

Registration is (check one):

New

Renewal (Certificate No. ____________________)

Status of Applicant (check only one):

Sole Proprietor

Corporation

Partnership

LLC

LLP

Unincorporated Association

Other (explain): ________________________________________________________________

If applicant is an entity, list state or country of incorporation/formation/organization: __________________________________________________

Service Mark is specifically described as: ____________________________________________________________________________________

_____________________________________________________________________________________________________________________

Service mark is being used in connection with the following services: ______________________________________________________________

____________________________________________________________________________________________________________________

State the mode or manner in which the service mark is being used in connection with the services provided: ______________________________

_____________________________________________________________________________________________________________________

State the classification for this service mark: _________________________________________________________________________________

(See instructions on reverse side - only one classification per application allowed)

Date mark first used anywhere: ________________________________; Date mark first used in Hawaii: _________________________________

I certify, under the penalties set forth in Section 482-3.5, Hawaii Revised Statutes, that (check one):

I am the applicant

I am the _______________________________________ of the applicant named in the foregoing application, that the applicant is the owner of the

(Office Held)

mark, that I am authorized to sign this application, and to the best of my knowledge and belief, the mark has been and is still in use, that no other person

has registered, either federally or in this State, or has the right to use, the mark either in the identical form thereof or in such near resemblance thereto

as to be likely, when applied to the services of the other person, to cause confusion, to cause mistake, or to deceive, and that the above statements are

true and correct.

________________________________________

_____________________________________________

_____________________________

(

Print Name)

(Signature)

(Date)

SEE INSTRUCTIONS ON REVERSE SIDE

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

(DEPARTMENTAL USE ONLY)

_____________________

Certificate of Registration No.

CERTIFICATE OF REGISTRATION OF SERVICE MARK

In accordance with the provisions of Chapter 482, Hawaii Revised Statutes, this Certificate of Registration is issued to secure the aforesaid applicant

the use of the said SERVICE MARK throughout the State of Hawaii for the term of five years from __________________________________________

to _____________________________________________ .

DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS

STATE OF HAWAII

REGISTRATION OF A SERVICE MARK WITH

THE DEPARTMENT DOES NOT GRANT YOU

Dated: __________________________________________________________

OWNERSHIP OF THE SERVICE MARK

________________________________________________________________

(Director of Commerce and Consumer Affairs)

B48 (Fee)

S18 (SH)