PAUL D. PATE Secretary of State State of Iowa The applicant with the Secretary of State under number registration. Address of Applicant: Street City Application for Renewal of Registered Mark One actual facsimile or specimen of mark must accompany this application is the owner of a mark which has been registered and hereby makes application for renewal of the County State ZIP Indicate One: (A) Individual If B, state names and addresses of partners: (B) Partnership (C) Corporation If C, state where incorporated: Description of mark The mark described above is still in use by the applicant in the state of Iowa and in the state(s) of : I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the preceding is true and correct. Signed: NOTES: Title: Date: 1. The application fee is $10.00. Make checks payable to SECRETARY OF STATE. 2. The information you provide will be open for public inspection under Iowa Code section 22.11 SECRETARY OF STATE Business Services Division Lucas Building, 1st Floor Des Moines, Iowa 50319 Phone: (515) 281-5204 FAX: (515) 242-5953 635_0117 rev 1/15 Website: sos.iowa.gov American LegalNet, Inc. www.FormsWorkFlow.com