Form 172 - Trade And Service Marks-Assignment Or Cancellation
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1Phone: (503) 986-2200
Trade and Service Marks—Assignment or Cancellation
Fax: (503) 378-4381
Secretary of State
Check the appropriate box below:
Print
Corporation Division
TRADE AND SERVICE MARK ASSIGNMENT
255 Capitol St. NE, Suite 151
Reset
(Complete only 1, 2, 3, 4, 5, 6, 7, 8, 9, 12)
Salem, OR 97310-1327
TRADE AND SERVICE MARK CANCELLATION
Save As
(Complete only 1, 2, 3, 4, 10, 11, 12)
R
N
:
For office use only
EGISTRY
UMBER
Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary.
1)
4)
C
N
M
A
T
S
M
D
ORRESPONDENT
AME AND
AILING
DDRESS
RADE OR
ERVICE
ARK
ESCRIPTION
O
A
’
N
A
2)
WNER OR
SSIGNOR
S
AME AND
DDRESS
D
M
W
O
F
3)
ATE
ARK
AS
RIGINALLY
ILED
A
C
SSIGNMENT ONLY
ANCELLATION ONLY
5)
C
N
(
)
W
M
W
R
10)
R
N
LASS
UMBER
S
FOR
HICH
ARK
AS
EGISTERED
EGISTRY
UMBER
6)
11)
N
B
A
A
Execution
AME AND
USINESS
DDRESS OF
SSIGNEE
Signature:
Date:
7)
I
A
I
C
, E
S
F THE
SSIGNOR
S A
ORPORATION
NTER THE
TATE OF
I
.
NCORPORATION
8)
I
A
I
C
, E
S
F THE
SSIGNEE
S A
ORPORATION
NTER THE
TATE OF
I
.
NCORPORATION
9)
E
XECUTION
Now, therefore, for good and valuable consideration, receipt of which is
FEES
hereby acknowledged, ASSIGNOR does hereby assign onto the
ASSIGNEE all right, title, and interest in and to the mark, together with the
Required Processing Fee
$50
good will of the business in which the mark is used (or that part of the
Processing Fees are nonrefundable.
good will of the business connected with the use of and symbolized by the
mark), and the registration thereof.
Please make check payable to
Assignor Signature:
“Corporation Division.”
NOTE:
Title:
Fees may be paid with VISA or
MasterCard. The card number and
Date:
expiration date should be submitted
on a separate sheet for your
In accordance with Oregon Revised Statute 192.410-192.490, the information on this application is public record.
protection.
We must release this information to all parties upon request and it will be posted on our website.
12)
C
N
D
P
N
ONTACT
AME (To resolve questions with this filing.)
AYTIME
HONE
UMBER (Include area code.)
172 (Rev. 1/04)
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