Form 558 - Change Of Ownership Name - State Of Ohio (Page 3 of 3) in pdf

Form 558 - Change Of Ownership Name - State Of Ohio Page 3

Instructions for Change of Ownership Name

This form must be used to change the owner's name on the records of a fictitious name, trade

name, trademark, service mark, or mark of ownership. Please check the appropriate box to

designate the type of name or mark being changed.

Current Registration Information

Please provide the name of the current owner of the name or mark. Also, provide the registration

number, the date of the original registration and the date of first use which can be found on the

original registration application.

Reason for Ownership Change

Please check the appropriate box to indicate the basis for the change in ownership.

The ownership may have changed through a merger, consolidation, conversion or qualification.

The owner's name may have changed through a name change within a merger, through an

Amendment, Restatement, Correction or Cancellation. If a foreign entity has registered a mark in

Ohio, the name may change in its jurisdiction of formation, but if the entity is not registered in Ohio,

this will not be reflected on our records. This change of name may be noted on this form. If an

individual owner legally changes his or her name, this may be reflected on this form.

New Owner Information

Please provide the name and addressof the new owner. If the new owner is an entity and

incorporated, licensed or registered in Ohio, please provide the charter/license/registration

number assigned by our office.

Additional Provisions

If the information you wish to provide for the record does not fit on the form, please attach

additional provisions on a single-sided, 8 1/2 x 11 sheet(s) of paper.

Signature

After completing all information on the filing form, please make sure that the form is signed by

the current owner (owner of the name or mark on our record).

**Note: Our office cannot file or record a document that contains a social security number

or tax identification number. Please do not enter a social security number or tax

identification number, in any format, on this form.

Form 558

Page 3 of 3

Last Revised: 12/01/2008

Form 558 - Change Of Ownership Name - State Of Ohio Page 3