Trademark / Service Mark Assignment - Commonwealth Of Massachusetts
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4TMA
Filing Fee $50.00
The Commonwealth of Massachusetts
SMA
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Trademark / Service Mark Assignment
FORM MUST BE TYPED
FORM MUST BE TYPED
(General Laws Chapter 110H, Section 7)
All information must be completed or this document will not be accepted for filing.
(1) Registrant’s legal name and business address:
a) Individual: ______________________________________________________________________________________
Last
First
Middle
Business address: _________________________________________________________________________________
Number
Street
_________________________________________________________________________________
City
State
Zip
or
b) Business Organization: _____________________________________________________________________________
Business address: _________________________________________________________________________________
Number
Street
_________________________________________________________________________________
City
State
Zip
(2) The mark is (complete one of the following):
a) Words only - If the mark is only words, the words in the mark are (include type style if it is claimed as part of the mark):
b) Design Only - If the mark is a design only, describe the design (include colors if they are claimed as part of the mark):
c) Words and Design - State the words in the mark (include color and type style if they are claimed as part of the mark) and
describe the design:
c110hs7 10/26/06
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