Application For Registration Or Renewal Of Trademark Or Service Page 3

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APPLICATION FOR TRADEMARK OR SERVICE MARK REGISTRATION & RENEWAL
Page 3
CERTIFICATION (Application must be acknowledged by a Notary Public) By signing the following, the Applicant affirms
that the following are true and accurate statements:
For all applicants: The applicant is the owner of the mark, the mark is in use, and to the best knowledge of the person
verifying the application, no other person has registered the mark in this State, or has the right to use the mark in this State
either in the identical form thereof or in such near resemblance thereto as to be likely, when applied to the goods or services of
the other person, to cause confusion, or to cause mistake, or to deceive.
For Renewals only: The mark described above is still in use in North Carolina for the goods or services for which registration
was initially granted and these goods or services are described in item #9 in this application.
For Corporations and Limited Liability Companies only: I certify that the applying corporation or limited liability company is
in good standing in the above-named state.
Name (Please Print):__________________________________________________
Signature: __________________________________________________________
Official Capacity: _____________________________________________________ Date:________________
NORTH CAROLINA
_______________ COUNTY
I, ______________________________________________, a Notary Public for ______________
County, North Carolina, do hereby certify that _________________________________________
personally appeared before me this day and acknowledged to me that he or she voluntarily signed the
foregoing document for the purpose stated therein and in the capacity indicated. That I either posses
personal knowledge of the identity of the principal or was provided with satisfactory evidence of the
principal’s identity.
Witness my hand and official seal, this the _____ day of ________, 20____
______________________________________________(Official Seal)
Notary Public
My Commission Expires: __________________, 20____
Month/Day
DID YOU REMEMBER TO INCLUDE:
______
The complete original signed and notarized application.
______
Three (3) original specimens depicting the mark “as currently used” in North Carolina., and
______
Two (2) black and white depictions of the Colored Design Mark if you did not claim color
______
Initial Application Processing fee of $75.00, or Renewal Application Processing fee of $35.00.
Please make check or money order payable to NC Secretary of State.
Mail all documents to:
Trademark Section, NC Department of the Secretary of State
PO Box 29622, Raleigh, NC 27626-0622

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