Form Cr172-Trade And Service Marks-Assignment Or Cancellation
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1Phone: (503) 986-2200
Trade and Service Marks—Assignment or Cancellation
Fax: (503) 378-4381
Check the appropriate box below:
For office use only
Secretary of State
Corporation Division
TRADE AND SERVICE MARK ASSIGNMENT
255 Capitol St. NE, Suite 151
(Complete only 1, 2, 3, 4, 5, 6, 7, 8, 9, 12)
Salem, OR 97310-1327
TRADE AND SERVICE MARK CANCELLATION
(Complete only 1, 2, 3, 4, 10, 11, 12)
Registry Number: ________________________________
Attach Additional Sheet if Necessary
Reset Form
Please Type or Print Legibly in Black Ink
1) C
N
M
A
4) D
T
S
M
ORRESPONDENT
AME AND
AILING
DDRESS
ESCRIPTION OF
RADE OR
ERVICE
ARK
2) O
A
’
N
A
WNER OR
SSIGNOR
S
AME AND
DDRESS
3) D
M
W
O
F
ATE
ARK
AS
RIGINALLY
ILED
ASSIGNMENT ONLY
CANCELLATION ONLY
5) C
N
(
)
W
M
W
R
10) R
N
LASS
UMBER
S
FOR
HICH
ARK
AS
EGISTERED
EGISTRY
UMBER
6) N
B
A
A
11) E
AME AND
USINESS
DDRESS OF
SSIGNEE
XECUTION
Signature: ________________________________________________________
Date: ____________________________________________________________
7) I
A
I
C
, E
S
F THE
SSIGNOR
S A
ORPORATION
NTER THE
TATE OF
I
.
NCORPORATION
8) I
A
I
C
, E
S
F THE
SSIGNEE
S A
ORPORATION
NTER THE
TATE OF
I
.
NCORPORATION
9) E
XECUTION
Now, therefore, for good and valuable consideration, receipt of which is hereby
acknowledged, ASSIGNOR does hereby assign onto the ASSIGNEE all right,
title, and interest in and to the mark, together with the good will of the business
in which the mark is used (or that part of the good will of the business
connected with the use of and symbolized by the mark), and the registration
thereof.
Assignor Signature: ________________________________________________
FEES
Title: _____________________________________________________________
Date: ____________________________________________________________
Make check for $10 payable to
“Corporation Division.”
NOTE: Filing fees may be paid
with VISA or MasterCard. The
12) C
N
D
P
N
– I
A
C
ONTACT
AME
AYTIME
HONE
UMBER
NCLUDING
REA
ODE
card number and expiration date
should be submitted on a separate
sheet for your protection.
CR172 (Rev. 12/99)
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