Cover Letter For Application For The Cancellation Of A Trademark Page 2

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APPLICATION FOR THE CANCELLATION OF A
TRADEMARK AND/OR SERVICE MARK
Pursuant to s. 495.101, Florida Statutes, the undersigned hereby submit(s) this application to cancel the following
trademark and/or service mark registration:
1. Mark to be cancelled: _______________________________________________________________________
2. Registration Number: _______________________________________________________________________
3. Date of Registration: ________________________________________________________________________
4. Signature of Owner(s):
___________________________________ ___________________________________
Owner’s Signature
Co-Owner’s Signature, if any
___________________________________ ____________________________________
Typed or Printed Name of Person Signing Above Typed or Printed Name of Person Signing Above
___________________________________
____________________________________
Typed or Printed Name of Owner
Typed or Printed Name of Co-Owner
STATE OF ____________________________
COUNTY OF __________________________
Sworn to and subscribed by me on n this _____ day of _______________, 20_____,
,
(Name of Individual Signing)
personally appeared before me,
who is/are personally known to me or
whose
identity (ies) I proved on the basis of
.
____________________________________
Notary Public’s Signature
(Seal)
____________________________________
Notary Public’s Printed Name
My Commission Expires: ______________________
(Attach additional sheet if necessary)
Filing Fee:
$50.00
Certified Copy (optional):
$52.50

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