State of California Secretary of State Name Change-Registered Owner of Trademark or Service Mark Pursuant to Business and Professions Code section 14220(b) IMPORTANT ­ Read instructions before completing this form. NAME CHANGE APPLICATION FOR (Check One): TRADEMARK SERVICE MARK 1. NAME OF OWNER OF MARK AS ORIGINALLY REGISTERED (ORIGINAL REGISTRANT) 2. BUSINESS ADDRESS OF ORIGINAL REGISTRANT CITY AND STATE ZIP CODE 3. BUSINESS STRUCTURE OF ORIGINAL REGISTRANT (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) _________________________________ 4. NAMES OF GENERAL PARTNERS, IF ORIGINAL REGISTRANT IS A PARTNERSHIP 5. TRADEMARK OR SERVICE MARK REGISTRATION NUMBER 7. NAME AND/OR DESCRIPTION OF TRADEMARK OR SERVICE MARK 6. DATE OF REGISTRATION 8. NEW NAME OF REGISTRANT 9. NEW BUSINESS ADDRESS OF REGISTRANT CITY AND STATE ZIP CODE 10. NEW BUSINESS STRUCTURE OF REGISTRANT (Check One and Complete) CORPORATION (State of Incorporation)_____________________________ LIMITED LIABILITY COMPANY (State of Organization) ____________________________ LIMITED PARTNERSHIP SOLE PROPRIETOR SPOUSES, AS COMMUNITY PROPERTY (State of Organization) __________________________ GENERAL PARTNERSHIP (State of Organization) _____________________________ DOMESTIC PARTNERS, AS COMMUNITY PROPERTY OTHER (Describe) _________________________________ 11. NEW NAMES OF GENERAL PARTNERS, IF REGISTRANT IS A PARTNERSHIP 12. Registrant certifies that the attached document is a true and correct copy of the original document showing proof of the name change, or registrant has attached a copy of the original document filed in another jurisdiction and certified by the filing office of that jurisdiction. _______________________________________________ DATE _______________________________________________ SIGNATURE OF AUTHORIZED PERSON SEC/STATE TM 110 (REV. 04/2015) ____________________________________________________ TYPE OR PRINT NAME AND TITLE American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING NAME CHANGE-REGISTERED OWNER OF TRADEMARK OR SERVICE MARK You must file this application with the Secretary of State's office only if the name of the owner of the mark has changed, not the ownership of the mark. If ownership of the mark has changed you must file an Assignment of Trademark or Service Mark. Registrant must attach a true and correct copy of the original document showing proof of name change, or a copy of the original document filed in another jurisdiction and certified by the filing office of that jurisdiction. Type or print in blue or black ink. Mail the application with original signature and proof of name change to Secretary of State, Trademark Unit, P.O. Box 942870, Sacramento, CA 94277-2870. There is no fee to file this form. Indicate at the top of the name change application the type of registration. Item 1. Item 2. Item 3. Enter the complete name of the registrant as it was originally registered. Enter the complete business address as it was originally registered. Identify the business structure of the registrant as it was originally registered, by checking the appropriate box. If a corporation, limited liability company, limited partnership or general partnership, list the state of origination. Enter the names of the general partners as originally registered, if registrant is a partnership. Enter the Trademark or Service Mark registration number. Enter the original date of registration of the Trademark or Service Mark. Enter the name and/or description of the Trademark or Service Mark. Enter the new name of the registered owner of the mark. Enter the new business address, if applicable. Item 4. Item 5. Item 6. Item 7. Item 8. Item 9. Item 10. Identify the new business structure, if applicable, of the registrant by checking the appropriate box. If a corporation, limited liability company, limited partnership or general partnership, list the state of origination. Item 11. Enter the new names of the general partners, if applicable, if registrant is a partnership. Item 12. Date, sign, and print the new name of the registrant. 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. American LegalNet, Inc. www.FormsWorkFlow.com