Form 171 - Trade And Service Marks-Registration
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1
2Phone: (503) 986-2200
Trade and Service Marks—Registration
Fax: (503) 378-4381
Print
Secretary of State
Corporation Division
255 Capitol St. NE, Suite 151
Reset
Salem, OR 97310-1327
Save As
R
N
:
EGISTRY
UMBER
For office use only
Please Type or Print Legibly in Black ink. Attach additional Sheets if Necessary.
For office use only
1)
6)
C
N
M
A
G
S
W
M
I
U
ORRESPONDENT
AME AND
AILING
DDRESS
OODS OR
ERVICES WITH
HICH THE
ARK
S
SED
Examples of goods are pizzas, shirts; examples of services are serving food and
selling clothing.)
A
’
N
A
(Owner)
2)
PPLICANT
S
AME AND
DDRESS
7)
E
M
M
W
M
I
U
XPLAIN
ODE OR
ANNER IN
HICH THE
ARK
S
SED
(Example: on goods, tags, labels, containers, etc.)
3)
I
A
I
C
, E
S
F THE
PPLICANT
S A
ORPORATION
NTER THE
TATE OF
I
.
NCORPORATION
D
T
S
M
4)
ESCRIPTION OF
RADE OR
ERVICE
ARK (Include all words, designs
and borders that comprise the mark)
8)
C
N
(
)
G
S
(See form 171A)
LASS
UMBER
S
OF
OODS OR
ERVICES
9)
D
M
W
F
U
A
B
A
ATE
ARK
AS
IRST
SED
NYWHERE
Y
PPLICANT OR
A
’
P
PPLICANT
S
REDECESSOR
10)
D
M
W
F
U
O
B
A
ATE
ARK
AS
IRST
SED IN
REGON
Y
PPLICANT OR
5)
S
F
M
R
.
PECIMEN OR
ACSIMILE OF
ARK IS
EQUIRED
A
’
P
PPLICANT
S
REDECESSOR
A specimen or facsimile of the mark is attached to this application.
11)
E
XECUTION
Applicant believes that applicant is the owner of the mark and no other person has the right to use such mark in Oregon, either in the identical form
thereof, or in such near resemblance thereto, as might be calculated to deceive, or to be mistaken therefore, and applicant declares under penalties
of perjury that this application is true, correct and complete.
FEES
Signature
Date
Required Processing Fee
$50
Processing Fees are nonrefundable.
Please make check payable to
“Corporation Division.”
In accordance with Oregon Revised Statute 192.410-192.490, the information on this application is public record.
We must release this information to all parties upon request and it will be posted on our website.
NOTE:
Fees may be paid with VISA or
12)
C
N
D
P
N
ONTACT
AME (To resolve questions with this filing.)
AYTIME
HONE
UMBER (Include area code.)
MasterCard. The card number and
expiration date should be submitted
on a separate sheet for your
protection.
171 (Rev. 8/05)
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