OFFICE OF SECRETARY OF STATE
THIS SPACE FOR OFFICE USE ONLY
CORPORATIONS DIVISION
A
MOUNT
2 Martin Luther King Jr. Dr. SE
R
:______________ I
: _______
ECEIVED
NITIALS
Suite 313 West Tower
C
/
HECK
Atlanta, Georgia 30334
CC/M.O. #: _____________________________
(404) 656-2817
D
OCKET
Brian P. Kemp
N
: ______________________________
UMBER
Secretary of State
ASSIGNMENT FORM
TRADEMARK OR SERVICE MARK
F
F
: $15.00
ILING
EE
I
O.C.G.A. §10-1-446,
,
N COMPLIANCE WITH THE REQUIREMENTS OF
THE UNDERSIGNED
HAVING ADOPTED AND USED A TRADEMARK
C
,
:
OR SERVICE MARK IN THIS STATE FOR PURPOSES PROVIDED IN THAT
ODE CHAPTER
DOES HEREBY CERTIFY THE FOLLOWING
1.
____________________________________________________________________________________________________
A
(C
R
O
)
SSIGNOR
URRENT
EGISTERED
WNER
2.
____________________________________________________________________________________________________
P
B
A
RINCIPAL
USINESS
DDRESS
3.
____________________________________________________________________________________________________
A
(N
O
)
SSIGNEE
EW
WNER
_____________________________
I
,
:
F A CORPORATION
ENTER STATE OR COUNTRY OF INCORPORATION
4.
____________________________________________________________________________________________________
P
B
A
RINCIPAL
USINESS
DDRESS
5.
____________________________________________________________________________________________________
D
M
ESCRIPTION OF
ARK
. ______________________________________
A
R
N
EGISTRATION
UMBER
. ______________________________________
B
I
R
D
NITIAL
EGISTRATION
ATE
. ______________________________________
C
E
D
XPIRATION
ATE
B
,
/
,
E IT KNOWN FOR AND IN CONSIDERATION OF MONIES
AND
OR OTHER GOOD AND VALUABLE CONSIDERATION TO IT IN HAND PAID
,
A
,
/
,
/
THE RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED
SAID
SSIGNOR DOES HEREBY SELL
AND
OR ASSIGN
AND
OR TRANSFER UNTO
A
,
,
SAID
SSIGNEE THE ENTIRE RIGHT
TITLE AND INTEREST IN AND TO THE SAID MARK AND REGISTRATION THEREOF
TOGETHER WITH
THE GOOD WILL OF THE BUSINESS IN WHICH THE MARK IS USED OR WITH THAT PART OF THE GOOD WILL OF THE BUSINESS
.
CONNECTED WITH THE USE OF AND SYMBOLIZED BY THE MARK
S
A
/O
____________________________________________________
IGNATURE OF
SSIGNOR
WNER
P
____________________________________________________
RINT OR TYPE NAME
T
(
)
____________________________________________________
ITLE
IF SIGNING FOR ENTITY
S
______________________________
C
______________________________
TATE OF
OUNTY OF
S
______
_____________________, 20 ____.
WORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF
_________________________________________
M
C
E
:_________________________________
Y
OMMISSION
XPIRES
N
P
OTARY
UBLIC
Return this completed and notarized form and a $15.00 filing fee to the Secretary of State at the above address before the expiration
date. Fees are non-refundable.
FORM TM03
(Rev. 4/2015)