Form Tma 58 - Trade-Mark Or Service-Mark Assignment Form

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Fees will increase September 1, 2003. If you file this report
before September 1, the fee is $5.00. If you file this report after
September 1, the fee is $15.00.
Contact Information
KANSAS SECRETARY OF STATE
TMA
Kansas Secretary of State
Trade-Mark or Service-Mark Assignment Form
Ron Thornburgh
58
Memorial Hall, 1st Floor
All information must be completed or this document will not be accepted for filing.
120 S.W. 10th Avenue
Topeka, KS 66612-1594
(785) 296-4564
Print
Reset
Please complete the form, print, sign and
mail to the Kansas Secretary of State with
the filing fee. Selecting 'Print' will print
the form and 'Reset' will clear the entire
form.
Do not write in this space
1. Trademark or Service-mark:
2. Classification:
3. Current owner:
4. Address:
Street address
City
State
Zip
5. Expiration date:
Month
Day
Year
The above does hereby assign said trademark or service-mark to the following:
6. New owner:
7. Address:
Street address
City
State
Zip
Signature of current owner
Instruction
Submit this application with the $15 filing fee. Please send a separate form for each additional assignment.
Notice: There is a $25 service fee for all returned checks.
Rev. 8/11/03 jb
K.S.A. 81-208

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