Form Tma-1-1.0 - Application For A Certificate Of Registration Of A Trade Or Service Mark

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SECRETARY OF THE STATE OF CONNECTICUT
MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470
DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106
860-509-6003
PHONE:
WEBSITE:
APPLICATION FOR
A CERTIFICATE OF REGISTRATION
OF A TRADE OR SERVICE MARK
USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY.
FILING FEE: $50
FILING PARTY
:
(CONFIRMATION WILL BE SENT TO THIS ADDRESS)
MAKE CHECKS PAYABLE TO "SECRETARY
OF THE STATE"
NAME:
ADDRESS:
CITY:
STATE:
ZIP:
1. NAME OF OWNER OF MARK:
2. ADDRESS OF OWNER:
ADDRESS:
CITY:
STATE:
ZIP:
3. STATE OR COUNTRY OF FORMATION OF THE OWNER
(IF OTHER THAN A NATURAL PERSON):
(PARTNERSHIPS - REFERENCE & ATTACH 81/2 X 11 LIST OF PARTNERS)
4. PLEASE PROVIDE A COMPLETE DESCRIPTION OF THE MARK:
5. THE GOODS OR SERVICES ON OR IN CONNECTION WITH WHICH THE MARK IS USED:
6. USE THIS SPACE TO DISCLAIM THE EXCLUSIVE RIGHT TO USE ANY DESCRIPTIVE, GENERIC OR
GEOGRAPHICALLY DESCRIPTIVE COMPONENTS OF THE MARK:
7. THE CLASS OF THE GOODS OR SERVICES STATED IN ITEM NUMBER 5:
NOTE: ONE APPLICATION PER GOOD/SERVICE.
FORM TMA-1-1.0
PAGE 1 OF 2
Rev. 12/2010

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