Tm/sm-15 State Of Illinois Trademark Or Service Mark - Illinois Secretary Of State

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REGISTRATION #:
State of Illinois
TM/SM-15
This space for use by Secretary of State.
Trademark or Service Mark
Secretary of State
pplication
Department of Business Services
Trademark Division
Black Ink
501 S. Second St., Rm. 330
Type, Laser Print or Legibly Print in
.
Springfield, IL 62756
217-524-0400
DO NOT STAPLE, GLUE OR TAPE
EXAMPLES TO THE APPLICATION
Payment may be made by check
Registration Fee: $10
or money order payable to Illinois
Secretary of State.
See additional page for instructions
and required documentation.
Items 1-4 refer to Registrant
1. Name of Registrant: ______________________________________________________________________________
2. Registrant is a (check one):
p Corporation
p Union
p General Partnership
p Limited Liability Partnership (LLP)
p Individual
p Association
p Limited Partnership (LP) p Limited Liability Company (LLC)
p Other (specify): _______________________________________________________________________________
3. a) If a Corporation, LP, LLP or LLC, indictate the State in which it is organized: _______________________________
b) If an LP or LLP, Name of one of the General Partners: _________________________________________________
4. Business Address:
Mailing Address:
Street:
Street:
City:
State:
ZIP:
City:
State:
ZIP:
5. Name of Mark: __________________________________________________________________________________
Mark is a (check one):
p Word Mark only
p Word with Design/Logo
p Design/Logo only
If the Mark involves a design/logo, briefly describe major features of the Mark: ________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
* No more than 215 Characters allowed in #5.
Printed by authority of the State of Illinois. July 2015 — 1 — C 246.14

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