Arkansas Secretary of State 1401 W. Capitol, Suite 250 Little Rock, AR 72201501-682-3409 www.sos.arkansas.gov TRADEMARK AND SERVICE MARK APPLICATION Important: Please read instructions before completing form. 1.Check One:New TrademarkTrademark RenewalNew Service MarkService Mark Renewal 2.Applicant222s Name: Street Address: City: State: Zip Code: 3.If applicant is a Business Entity (Inc., LLC, PLLC, etc.), list state of incorporation: If applicant is a Partnership, list state of organization and names of General Partners: 4.Trademark or Service Mark Classification number: Classification Title: 5.The mark is used to promote, or in connection with, the following goods or services: 6.Describe how the mark is used in connection with the goods or services: 7.Description of the mark being applied for: (2nd sheet may be attached for longer descriptions) 8.The mark has been used in business by the Applicant (or predecessor) since: (MONTH / DAY/ YEAR) and used in the state of Arkansas since: (MONTH / DAY/ YEAR)Federal Trademark Registration and/or Serial Number, if applicable: (REGISTRATION #) AND/OR (SERIAL #) 9.This application must be accompanied by 3 original specimens of the mark as it is actually used. Photocopies are NOT acceptable. AFFIDAVIT By signing below, Applicant is stating that said Applicant is the owner of the mark, that the mark is in use, and that no other person has registered either Federally or in this State, or has the right to use the mark in this State either in identical form thereof or in such a near resemblance thereto as might be calculated to deceive or to be mistaken thereof. If renewing the mark, Applicant states that the mark has been in use during the past five (5) years. 10.I, the undersigned, being first duly sworn, state that I am the Applicant, or a lawfully authorized representative of the Applicant, thatI have read the application222s instructions and completed the above application and know its contents and that the facts statedtherein are true. Furthermore, I understand that the statements made herein are under oath, and that knowingly making a falsestatement is a Class C felony pursuant to Ark. Code Ann 247 5-53-102 : Signature Title Printed Name Contact Telephone Number 11.State of Arkansas County of Subscribed and sworn before me, a Notary Public, on {seal} this day of , My commission expires:Notary Public: Filing Fee $50.00 payable to Arkansas Secretary of State Questions? Check out the Trademark FAQs Online! Rev. FOR OFFICE USE ONLY File Number: Expiration Date: American LegalNet, Inc. www.FormsWorkFlow.com