Form Dos-246 - Original Application To Register A Servicemark - 2008
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2NYS DEPARTMENT OF STATE
REG NO
MISCELLANEOUS RECORDS
One Commerce Plaza, 99 Washington Avenue
Albany, NY 12231-0001
Original Application to Register a Servicemark
Please read the instructions prior to completing this form; attach additional sheets as needed.
1. APPLICANT NAME
2. ADDRESS
NUMBER AND STREET
CITY
STATE
ZIP
3. IF A CORPORATION, ENTER STATE IN WHICH INCORPORATED AND
IF A PARTNERSHIP, ENTER STATE IN WHICH ORGANIZED
4. IF A PARTNERSHIP, LIST THE NAMES OF ALL GENERAL PARTNERS
5. DESCRIBE THE SERVICEMARK, INCLUDING A WRITTEN DESCRIPTION OF DESIGN FEATURES, IF ANY (DO NOT GLUE A FACSIMILE TO THIS FORM)
6. STATE THE SPECIFIC SERVICES FOR WHICH THE MARK IS USED
7. DESCRIBE THE MODE OR MANNER IN WHICH THE MARK IS USED
8. CLASS NUMBER(S)
9. DATE OF
(A) IN NEW YORK STATE
(B) ANYWHERE
FIRST USE
The applicant is the owner of the mark, the mark is in use, and, to the knowledge of the person
FOR OFFICE USE ONLY
verifying the application, no other person has registered, either federally or in this state, or has the
right to use such mark either in the identical form or in such near resemblance as to be likely, when
applied to the services of such other person, to cause confusion, or to cause mistake, or to deceive.
The undersigned applies to register the aforesaid mark pursuant to Article 24 of the General
Business Law and affirms under the penalties of perjury that the statements herein made, including
any attached papers, are true.
(Corporation, Association, Firm, etc.)
By:
(Signature and Title of Officer)
(Date)
DOS-246 (Rev. 5/08)
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