Department Of State Bureau Of Corporations And Charitable Organizations Trademark/service Mark Renewal Or Assignment

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PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Return document by mail to:
Trademark/Service Mark
Renewal or Assignment
Name
DSCB:54-1114/1115 (rev. 7/2015)
Address
*11145*
City
State
Zip Code
11145
Return document by email to:
_________________________________
Read all instructions prior to completing.
Fee: $50 - Renewal
$50 - Assignment
Check one:
Renewal of Registration of Mark (§ 1114)
Assignment of Registration of Mark (§ 1115)
In compliance with the requirements of the applicable provisions (relating to duration and renewal or relating to
assignment), the undersigned, having heretofore duly registered a trademark or service mark in this Commonwealth and
desiring to renew/assign such registration, hereby states that:
1. Check one pertaining to registration:
Renewal: The name and description of the mark is (a specimen of the mark the registration of
which is to be renewed showing actual use of the mark on or in conjunction with the goods or
services accompanies this application as Exhibit A and is incorporated herein by reference):
Assignment: The name and description of the mark is (a facsimile of the mark the registration
of which is to be assigned accompanies this assignment as Exhibit A and is incorporated herein by
reference):
2. The residence, location or place of business of the applicant/assignor is:
Number and street
City
State
Zip
County

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