Form Tmsm - 05 - Application To Cancel A Registered Trade Or Service Mark

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TMSM – 05
Rev 10/02
New Jersey Division of Revenue
APPLICATION TO CANCEL A REGISTERED TRADE OR SERVICE MARK
This form may be used by applicants seeking to cancel a registered State trade or service mark pursuant to
NJSA 56. Applicants are responsible for strict adherence to all requirements set forth in State law.
1. Trade/Service Mark Number: (as assigned by the Treasurer and listed on the Certificate of Registration)
2. Owner Information:
a. Name: (must match the name shown on the Division of Revenue’s records)
b. Business Address: (must match the address shown on the Division of Revenue’s records)
3.Signature(s):
The undersigned request that the mark be cancelled.
_______________________________________
___________________
(Signature of Owner, or a Member of the Firm, or an
(Date)
Officer of the Corporation or Business Applying)

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