8. Provide the class number and title of the goods or services (see attachment). Use only one class code per renewal:
Class number:
Title:
9. Provide a brief description of the goods or services within the class (i.e., what your product is, or what service you
provide):
10. List the mode or manner in which the mark is used to identify the goods or services (e.g.: goods - labels on cans,
bags, wrappers, etc.; tags, nameplates affixed directly to product; services - labels on laundry bags, advertising,
window signs, etc.):
11. An application to register the mark or portions or a composite has been filed by the applicant or a predecessor in
interest in the U.S. Patent and Trademark office:
Yes
No
If yes, provide filing date, serial number of each application, the status and, if any application was finally refused
registration or has not otherwise resulted in registration, the reasons therefore:
12. Date of first use by applicant or predecessor (the mark must be in use before it can be registered):
a. Anywhere:
(Date – mm/dd/yyyy)
b. In this state:
(Date – mm/dd/yyyy)
13. One photocopy or facsimile of the mark as it is actually used must accompany this application.
14. The applicant is the owner of the mark. The mark is in use and to the knowledge of the person verifying this
application, no other person has registered, either federally or in this state, or has the right to use such mark either in
the identical form thereof or in such near resemblance as to be likely, when applied to the goods or services of such
other person, to cause confusion or to cause mistake or to deceive.
Signature: ___________________________________________
Date:
(mm/dd/yyyy)
Print Name:
Contact Person:
Title:
Daytime Phone Number:
Email:
(Email provided will receive filing evidence)
*May list multiple email addresses
TM-Renewal - Revised October 2015
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