Form Ss-4262 - Cover Form For Assignment Of Trademark Or Service Mark
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1For Office Use Only
COVER FORM FOR
ASSIGNMENT OF
TRADEMARK OR SERVICE MARK
Trademarks
312 Eighth Avenue North
6 th Floor, William R. Snodgrass Tower
Nashville, TN 37243
In compliance with the requirements of T.C.A. §47-25-507, the undersigned hereby submits an assignment of a trade-
mark or service mark registered in Tennessee:
1. The name and description of the registered mark is as follows:
2. Date of original registration:
3. The owner of record of the registered mark (assignor) is
whose address is
4. The name of the new owner (assignee) is
whose address is
5. If the new owner (assignee) is a corporation, the state of incorporation is
6. If the new owner (assignee) is a partnership, the state where the partnership is organized is
and the names of the general partners are
7. The executed assignment document is attached to this form. (A photocopy of such a document may
be submitted if it is certified by any of the parties thereto, or their successors, to be a true and correct
copy of the original.)
Signature
Type or Print Name & Title
See Instructions on Back
SS-4262 (Rev. 9/00)
RDA 1764
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