Trade Or Service Mark Application Form 901 Page 8
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910. SPECIMENS (Check the applicable boxes below and enclose three (3) original specimens
supporting the goods/services described in Item 7. Include at least one (1) specimen for each class)
For Trademarks Only
For Service Marks Only
Actual Labels
Advertising Leaflets
Actual Tags
Advertising Brochures
Photographs of Goods/Containers Showing the
Mark
Menus Showing the Mark
Front Panels of a Paper Container Bearing the
Mark
Business Cards that Reference Services
Other:
Other:
11. DECLARATION OF OWNERSHIP
Applicant declares that the applicant is the owner of the mark, that the mark is in use, and that to the
knowledge of the person verifying the application, no other person has registered the mark, either
federally or in this state, or is entitled to use the mark in this state, either in the identical form used by
the applicant or in a form that is likely, when used on or in connection with the goods or services of
the other person, to cause confusion or mistake, or to deceive, because of its resemblance to the mark.
12. SIGNATURE AND VERIFICATION
DATE
SIGNATURE OF AUTHORIZED PERSON
TYPE OR PRINT NAME AND TITLE
TO BE COMPLETED BY A NOTARY PUBLIC:
)
STATE OF
)
COUNTY
On
,
personally
appeared before me, and being first duly sworn declared that he/she signed this application in the
capacity designated, if any, above application and the statements therein contained are true and
and further stated that he/she has read the above application and the statements therein are true and
correct.
Print
Reset
(seal)
NOTARY PUBLIC SIGNATURE
Form 901
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Parent category: Business