Form 116-Rna - Assignment printable pdf download

Form 116-Rna - Assignment

J. Kenneth Blackwell

Prescribed by

Please obtain fee amount and mailing instructions from the Forms

Inventory List (using the 3 digit form # located at the bottom of this

form). To obtain the Forms Inventory List or for assistance, please

call Customer Service:

Central Ohio: (614)-466-3910 Toll Free: 1-877-SOS-FILE (1-877-767-3453)

ASSIGNMENT

being the owner of record in the Office of the Secretary of State

of the following registration: (check appropriate box and fill in the name as registered)

Trade Name

Fictitious Name

Trade Mark

Service Mark

Mark of Ownership

bearing registration number

for the sum of One Dollar ($1.00) and other valuable

considerations, does hereby sell, assign, and transfer all right, title and interest in said mark or name to

whose business address is

(street name and address)

County,

(city, village, township)

(state)

(zip)

NOTE:

P.O. Box addresses are not acceptable

This document is signed by a corporate officer, association member or officer,

or the individual owner.

* If the assignor is a PARTNERSHIP, ALL general partners must sign.

If only one partner is authorized to sign, you must include a copy of the resolution

authorizing the signatory.

Signature:

(prior owner's signature)

Name:

Note:

This filing does not extend the registration period. Please check your certificate after issuance for your expiration date.

*O.R.C. 1775.24(B)(2)

116-RNA

Page 1 of 1

Version: May 1, 1999

Form 116-Rna - Assignment