Form F0023 - Application To Register Or Renew Trade And Service Marks 1996 Page 3

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F0023 - Page 3 of 4
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
P.O. BOX 136, JACKSON, MS 39205-0136
(601) 359-1333
*0023-3-4*
Application to Register or Renew Trade and Service Marks
11. Describe in detail the mark (a drawing) as you want it registered.
12. Attached hereto are three specimens or facsimiles of the mark in use.
13. Consent (if applicable). SEE INSTRUCTIONS.
Give name and address of owner of existing mark and attach hereto letter of consent.
14. I, the owner of the mark, a member of the firm or an officer of the corporation or
association applying, 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 to cause mistake or to deceive.
Signature
Name
and Title
(Please keep
(Print name.)
writing within
blocks.)
page 3 of 4
F0023 [Rev. 11/96]

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