Assignment Of Registration Of A Trademark Or Service Mark, Certification Mark, Or Collective Mark Form - Minnesota Secretary Of State
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1For your convenience, this form has
been designed to be completed
online. You must have Acrobat
Minnesota Secretary of State
Reader 7.0 or above to use this new
ASSIGNMENT OF REGISTRATION OF
feature. Once your form is
completed, be sure to select "Print"
A TRADEMARK OR SERVICE MARK,
at the bottom of the screen to
CERTIFICATION MARK, OR COLLECTIVE MARK
capture your data entry for printing.
After printing, sign and send
Filing Fee: $15.00
applicable fees as required.Note:
Selecting "Reset" will clear all data
entry from this page. To print a blank
form, go to File->Print.
File Number: ___________________________
Class: _________________________
MARK AS DESCRIBED ON CERTIFICATE: _______________________________________________________________
___________________________________________________________________________________________________
Name of Present Registrant:
___________________________________________________________________________________________________
Address: ____________________________________________________________________________________________
Street
City
State
Zip
The present registrant has filed this mark and is assigning this registration and all rights to and interest in this mark, including
any good will connected to the mark for valid consideration which has been received.
This mark is assigned to:
Name: _____________________________________________________________________________________________
Address: ____________________________________________________________________________________________
Street
City
State
Zip
I, the undersigned, certify that I am signing this document as the person whose signature is required, or as agent of the person(s)
ate of Formation, if an entity: ______________________________________
whose signature would be required who has authorized me to sign this document on his/her behalf, or in both capacities. I further
certify that I have completed all required fields, and that the information in this document is true and correct and in compliance with
I certify that I am authorized to execute this assignment and I further certify that I understand that by signing this assignment,
the applicable chapter of Minnesota Statutes. I understand that by signing this document I am subject to the penalties of perjury as set
I am subject to the penalties of perjury as set forth in section 609.48 as if I had signed this assignment under oath.
forth in Section 609.48 as if I had signed this document under oath.
_____________________________________________
____________________________________________
Signature (on behalf of present registrant or authorized agent)
(Print name and title)
Name and telephone number of contact person: ______________________________________ (____) ________________
A separate assignment is required for each class.
Make check payable to the MN Secretary of State.
FILE IN-PERSON OR MAIL TO:
Minnesota Secretary of State - Business Services
Retirement Systems of Minnesota Building
60 Empire Drive, Suite 100
St Paul, MN 55103
(Staffed 8:00 - 4:00, Monday - Friday, excluding holidays)
All of the information on this form is public. Minnesota law requires certain information to be provided for this type of filing. If
that information is not included, your document may be returned unfiled. This document can be made available in alternative
formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing)
communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803. The
Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin,
age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the
provision of service.
TrademarkAssignmentRev.08-01-10
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