Form F0023 - Application To Register Or Renew Trade And Service Marks 2008 Page 3

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OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
F0023—Page 3 of 4
P. O. BOX 136, JACKSON, MS 39205-0136
601-359-1333
Application to Register or Renew Trade and Service Marks
Describe in detail, using words, the mark as you want it registered.
11.
Attach three 3 specimens or facsimiles of the mark in use.
12.
13. Consent (if applicable). SEE INSTRUCTIONS. If another person or company currently owns this mark,
give name and address of owner of existing mark and attach hereto letter of consent.
I, the owner of the mark, a member of the firm or an officer of the corporation or association applying,
14.
attest that the mark is in use, and that to my knowledge, no other person has registered, either Federally
or in this state, or has the right to use such mark, except as provided for in item 13 above, either in the
identical form or in such near resemblance thereto as to be like, when applied to the goods or services of
such person to cause confusion, or cause mistake or to deceive.
Name and Title (Please print name.)
Signature (Please keep writing within block.)
F0023 (Rev. 9/08)

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