BCS/CD-602 (Rev. 04/11)
MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
BUREAU OF COMMERCIAL SERVICES
(FOR BUREAU USE ONLY)
Date Received
-
M
INSIGNIA IDENTIFICATION NUMBER
APPLICATION FOR REGISTRATION OF INSIGNIA
(Please read information and instructions on reverse side)
Pursuant to the provisions of Act 281, Public Acts of 1927, the undersigned executes the following Application:
1.
The name of the association, lodge, order, society, union or other entity applying for the registration is:
2.
The business address of the application named in Item 1 is:
3.
Application is made to register a:
___________________________________________________________________________
(enter one of the following words: badge, button, decoration, charm, name, emblem, rosette or identify other insignia)
4.
Describe the badge, button, decoration, charm, name, emblem, rosette or other insignia including lettering styles,
colors, words, etc. which are an inherent part of the insignia:
5. The registration shall be for the use, benefit and on behalf of all associations, degrees, branches, subordinate
lodges and auxiliaries of said association, lodge, order, fraternal society, beneficial association, or fraternal and
beneficial society or association, historical, military or veterans' organization, labor union, foundation, federation,
or any other society, organization or association, degree, branch, subordinate lodge or auxiliary thereof and the
individual members and those who thereafter become members thereof, throughout the State of Michigan.
This application is executed this _____________ day of _____________________, ______________ by the chief officer
or officers of the application acting in an official capacity for the applicant.
(Signature)
(Signature)
(Signature)
(Type or Print Name)
(Type or Print Name)
(Type or Print Name)