Form Pto-1594 - Recordation Form Cover Sheet
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U.S. DEPARTMENT OF COMMERCE
Form PTO-1594 (Rev. 07/05)
United States Patent and Trademark Office
OMB Collection 0651-0027 (exp. 6/30/2008)
RECORDATION FORM COVER SHEET
TRADEMARKS ONLY
To the Director of the U. S. Patent and Trademark Office: Please record the attached documents or the new address(es) below.
1. Name of conveying party(ies):
2. Name and address of receiving party(ies)
Yes
Additional names, addresses, or citizenship attached?
No
Name:________________________________________
Internal
Association
Individual(s)
Address:______________________________________
General Partnership
Limited Partnership
:______________________________
Street Address
Corporation- State:_________________________
City:________
____________________________________________
_________________________________
Other
State:________________________________________
Citizenship (see guidelines)_______________________
Country:_____________________Zip:______________
Additional names of conveying parties attached?
Yes
No
Association
Citizenship _________________________
General Partnership
Citizenship ____________________
3. Nature of conveyance )/Execution Date(s) :
Limited Partnership
Citizenship ____________________
Execution Date(s)_______________________________
Corporation Citizenship____________________________
Assignment
Merger
Other____________
Citizenship ___________________
Security Agreement
Change of Name
If assignee is not domiciled in the United States, a domestic
Yes
No
representative designation is attached:
Other_____________________________________
(Designations must be a separate document from assignment)
4. Application number(s) or registration number(s) and identification or description of the Trademark.
B. Trademark Registration No.(s)
A. Trademark Application No.(s)
Additional sheet(s) attached?
Yes
No
C. Identification or Description of Trademark(s) (and Filing Date if Application or Registration Number is unknown):
5. Name & address of party to whom correspondence
6. Total number of applications and
concerning document should be mailed:
registrations involved:
Name:________________________________________
7. Total fee (37 CFR 2.6(b)(6) & 3.41)
$_____________
Internal Address:________________________________
Authorized to be charged by credit card
Authorized to be charged to deposit account
Street Address:
Enclosed
8. Payment Information:
City:__________________________________________
a. Credit Card
Last 4 Numbers ________________
Zip:________________
State:____________________
Expiration Date ________________
Phone Number: _________________________________
b. Deposit Account Number _____________________
Fax Number: ___________________________________
Authorized User Name _______________________
Email Address: _________________________________
9. Signature:
Signature
Date
Total number of pages including cover
sheet, attachments, and document:
Name of Person Signing
Documents to be recorded (including cover sheet) should be faxed to (571) 273-0140, or mailed to:
Mail Stop Assignment Recordation Services, Director of the USPTO, P.O. Box 1450, Alexandria, VA 22313-1450
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