Form Cr2e005 - Mark Renewal Application Form - 2001

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MARK RENEWAL APPLICATION
Name and Address of Owner:
Return To: Division of Corporations
P.O. Box 6327
Tallahassee, FL 32314
Mark Registered:
Registration Number:
Date Filed:
Renewal Date:
Class(es) Filed:
Renewal statement pursuant to section 495.071, Florida Statues. Below you must state the mark is still in use in
Florida or the reason for its nonuse.
If applicant is a corporation, enter the state of incorporation: _____________
I
, being sworn, depose and say that I am the owner or that I am
authorized to sign on behalf of the owner of the trademark and/or service mark referenced herein and make this
application and verification on my/the owner’s behalf. I further acknowledge that I have read the application
and know the contents thereof and that the facts stated herein are true and correct.
________________________________________
Typed or Printed Name of Owner
_______________________________________
Owner’s Signature or Authorized Person’s
Signature
STATE OF_______________________
COUNTY OF_____________________
On this
day of
,
,
personally appeared before me,
who is personally known to me
whose identity I proved on the basis of
(Seal)
Notary Public’s Signature
Notary Public’s Printed Name
Fee: $87.50 Per Class
Certificate of Renewal: $8.75 (Optional)
CR2E005(6/01)

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