Application For Certificate Of Renewal Of A Registered Mark
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1OFFICE OF THE SECRETARY
OF THE STATE
30 TRINITY
STREET
P.O. BOX 150470
HARTFORD,
CT 06 1150470
APPLICATION
FOR CERTIFICATE
OF RENEWAL
OF A REGISTERED
MARK,
Rev. 12/1999
(Can befiled only within 6 months prior to the expiration of a registration)
1. Name of Record Owner:
!. State of Formation of the Owner if other than a natural person..
3. New Address of Owner (if applicable):
1. Connecticut Registration Number:
The owner of the mark, which is the subject of this application, asserts that the mark has been and is still
.n use in Connecticut. The owner hereby applies for renewal of the registration bearing the number stated
.n Number 4 above.
EXECUTION:
I hereby declare under the penalties of false statement that the statements made in
the foregoing application is true.
5.
Date
6.
Name of Signatory
7.
Title of Signatory ifapplicable
8.
Signature
9. The applicant must submit three specimens or photographs of the mark as actually used in this state.
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