State Form 4430 - Application For Registration Of Trademark / Service Mark - Indiana Secretary Of State

Download a blank fillable State Form 4430 - Application For Registration Of Trademark / Service Mark - Indiana Secretary Of State in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete State Form 4430 - Application For Registration Of Trademark / Service Mark - Indiana Secretary Of State with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Reset Form

APPLICATION FOR REGISTRATION

CONNIE LAWSON

OF TRADEMARK / SERVICE MARK

SECRETARY OF STATE

TRADEMARKS DIVISION

State Form 4430 (R8 / 4-12)

302 W. Washington St., Rm. E018

$ 10.00

FILING FEE:

Approved by State Board of Accounts, 2006

Indianapolis, IN 46204

Telephone: (317) 232-6540

INSTRUCTIONS:

1. If the Mark is the same or resembles a Mark presently registered in this state, attach an affidavit of consent by registrant, signed and verified under oath.

2. Section #5 should contain all the words you wish to register, even if Mark involves a symbol or design.

3. Complete section #7 and #12 only if applicable. All other sections should be completed.

4. Approximate dates of first use are acceptable in section #10. These dates must be prior to the date of signing this application.

5. Include three (3) flat specimens no larger than 8.5" x 11”. If section #6 was answered “yes”, then an additional specimen must be included. This specimen

should be on white plain paper showing only the Mark , in black ink and suitable for computer scanning.

6. Please visit our website at

APPLICANT: INDIVIDUAL, ASSOCIATION, PARTNERSHIP, CORPORATION, OTHER

1. Name of applicant

Telephone number of applicant

(

)

2. Address (number and street, city, state, and ZIP code)

3. Contact person (name and address of contact, if correspondence about this application should go to a party other than the signatory)

Telephone number of contact person

(

)

4. Type of applicant: (check the appropriate box)

Association

Limited Liability Company (State of Organization) ________________

Individual

Partnership of any type (Attach name and address of all partners)

Corporation (State of Incorporation) ______________________________

Other (Describe) __________________________________________

TRADEMARK / SERVICE MARK INFORMATION

5. Trademark / Service Mark (include all words to be registered)

6. Does the Mark involve a symbol, design or any non-standard type face? If “yes”, then briefly describe, in thirty (30) words or less, major feature(s) of design.

Yes

7. DISCLAIMER: Disclaim words, phrases, and pictorial features which are merely descriptive of the goods or services or are primarily geographic. Names of cities, states,

and designation of corporate status are normally considered descriptive; e.g., Inc., company, Indiana, USA, .com, etc. No claim is made to the exclusive

right to use the symbol / word(s) ________________________________________________________________________________________________________

apart from the Mark as shown.

8. Class number (select only ONE class per form -- see page 2 for class)

9. Concisely describe specific goods (classes 1-34) or services (classes 35-45) used in connection with the Mark. The Mark is used on, or in connection with:

10. Date the Mark was first used in commerce in Indiana by

Date the Mark was first used in commerce anywhere in USA,

applicant or predecessor: (month, day, year)

including Indiana: (month, day, year)

11. Check all boxes in either (a) or (b) that apply to how the Mark is used. Selection must correspond with the class chosen in section #8.

(a) Trademark classes 1-34 only: (by applying it)

Directly to goods

to tags or labels affixed to the goods

by displaying the mark in physical association

to the containers for the goods

to tags or labels affixed to the containers for the goods

with the goods in the sale or distribution thereof

Other: (please specify) ______________________

(b) Service Mark classes 35-45 only: (by displaying it)

in advertisement of the service

Other: (please specify) ___________________________

on documents, wrappers, or articles delivered in connection with the service rendered

12. If either of the above first uses of the Mark were by a predecessor in business, give name, address, and specify which use(s) of the Mark were by predecessor:

Page 1 of 2