State of California Secretary of State Assignment of Trademark or Service Mark (Business and Professions Code section 14220(a)) IMPORTANT ­ Read instructions before completing this form. ASSIGNMENT APPLICATION FOR (Check One): TRADEMARK SERVICE MARK 1. NAME OF ASSIGNOR (Owner of mark as registered in the Secretary of State's office) 2. NAME OF ASSIGNEE (Person to whom ownership of mark is transferred) 3. BUSINESS ADDRESS OF ASSIGNEE CITY STATE ZIP CODE 4. BUSINESS STRUCTURE OF ASSIGNEE (Check One and Complete) CORPORATION (State of Incorporation)_____________________________ LIMITED LIABILITY COMPANY (State of Organization) ____________________________ LIMITED PARTNERSHIP (State of Organization) ____________________________ GENERAL PARTNERSHIP (State of Organization) ____________________________ SOLE PROPRIETOR SPOUSES, AS COMMUNITY PROPERTY DOMESTIC PARTNERS, AS COMMUNITY PROPERTY OTHER (Describe) ________________________________ 5. NAMES OF GENERAL PARTNERS, IF ASSIGNEE IS A PARTNERSHIP 6. NAME AND/OR DESCRIPTION OF TRADEMARK OR SERVICE MARK 7. TRADEMARK OR SERVICE MARK REGISTRATION NUMBER 8. DATE OF REGISTRATION 9. Assignor hereby assigns to assignee all rights, title and interest in the mark, together with the good will of the business in which the mark is used (or that part of the good will of the business connected with the use of and symbolized by the mark) and the registration thereof. Please Note: Signature must be acknowledged by a Notary Public. _________________________________________________ DATE _________________________________________________ SIGNATURE OF ASSIGNOR-OWNER OF MARK ___________________________________________________ TYPE OR PRINT NAME AND TITLE 10. RETURN ACKNOWLEDGMENT TO: (Type or Print) NAME ADDRESS CITY/STATE/ZIP THIS SPACE FOR FILING OFFICER USE TRADEMARK OR SERVICE MARK REG. NO. _______________________ ASSIGN. NO. ____________________ American LegalNet, Inc. www.FormsWorkFlow.com SEC/STATE TM 108 (REV. 04/2015) (Page 1 of 2) FILING FEE: $30.00 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of _____________________________) On _________________________ before me, _________________________________________ (insert name and title of the officer) personally appeared ______________________________________________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ______________________________ (Seal) American LegalNet, Inc. www.FormsWorkFlow.com SEC/STATE TM 108 (REV. 04/2015) (Page 2 of 2) FILING FEE: $30.00 Instructions for Completing Assignment of Trademark or Service Mark Assignments must be filed with the Secretary of State's office within three months after the date thereof or prior to the subsequent purchase together with the filing fee of $30.00. Type or print in blue or black ink. Mail the assignment with original signatures and filing fee to the Secretary of State, Trademark Unit, P.O. Box 942870, Sacramento, CA 94277-2870. Indicate at the top of the application which type of registration is being assigned. Item 1. Enter the complete name of the assignor (owner of the mark as currently registered with the Secretary of State's office). Item 2. Enter the complete name of the assignee (person to whom ownership of the mark is being transferred). Item 3. Enter the complete business address of the assignee. Item 4. Identify the business structure of the assignee by checking the appropriate box. If a corporation, limited liability company, limited partnership or general partnership, list the state of origination. Item 5. Enter the names of the general partners, if assignee is a partnership. Item 6. Enter the name and/or description of the Trademark or Service Mark as registered. Item 7. Enter the Trademark or Service Mark registration number. Item 8. Enter the original date of registration of the Trademark or Service Mark. Item 9. Date, sign, and print the name of the assignor (owner of the mark as currently registered with the Secretary of State's office). The signature must be acknowledged by a notary public on the reverse side of the assignment. If the registrant is a corporation, an officer of the corporation must sign the application. Include the title of the officer (i.e. President, Vice-President, Secretary, etc.) If the registrant is a limited liability company, a member or manager of the limited liability company must sign the application. Include the title; either Member or Manager. If the registrant is a partnership, a general partner of the partnership must sign the application. Include the title of the general partner. This office will accept a statement attached to the application that the individual signing the application is authorized to do so for the registrant. Item 10. Enter the name and address of the person or company to receive the Certificate of Registration for the remainder of the term. American LegalNet, Inc. www.FormsWorkFlow.com