State of California Secretary of State RENEWAL OF TRADEMARK OR SERVICE MARK Pursuant to Business and Professions Code section 14217 IMPORTANT ­ Read instructions before completing this form. RENEWAL APPLICATION FOR (Check One): 1. NAME OF OWNER OF MARK (REGISTRANT) 2. BUSINESS ADDRESS OF REGISTRANT CITY STATE ZIP CODE TRADEMARK SERVICE MARK 3. BUSINESS STRUCTURE OF 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 REGISTRANT IS A PARTNERSHIP 5. NAME AND/OR DESCRIPTION OF TRADEMARK OR SERVICE MARK 6. TRADEMARK OR SERVICE MARK REGISTRATION NUMBER 7. DATE OF REGISTRATION 8. The mark has been and is still in use within the State of California by the registrant in the form and manner specified in the present registration. I certify under penalty of perjury under the laws of the state of California that the foregoing statement is true and correct. _________________________________________________ DATE _________________________________________________ SIGNATURE OF AUTHORIZED PERSON ________________________________________________ TYPE OR PRINT NAME AND TITLE THIS SPACE FOR FILING OFFICER USE 9. RETURN ACKNOWLEDGMENT TO: (Type or Print) TRADEMARK OR SERVICE MARK REG. NO. _______________________ NAME ADDRESS CITY/STATE/ZIP RENEWAL NO. __________________ American LegalNet, Inc. www.FormsWorkFlow.com SEC/STATE TM 109 (REV. 04/2015) FILING FEE: $30.00 INSTRUCTIONS FOR COMPLETING RENEWAL OF TRADEMARK OR SERVICE MARK Application for renewal must be received by the Secretary of State within (but not before) the six month period prior to the date of expiration of the current registration together with the renewal fee of $30.00. Include with the application one original specimen that shows how the mark is currently used on the goods or in connection with services identified in the application. The original specimen should be no larger than 8 ½" x 11" and should lay flat. Original specimens that have been altered or defaced in any manner are not acceptable. Do not submit metal of any kind, words typed on cards or sheets of paper. Computer generated prototypes are not acceptable. Type or print in blue or black ink. Mail your application with original signature, filing fee, and specimen indicating current use 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 you are renewing. The information required below must match the information provided on the original application. Item 1. Item 2. Item 3. Enter the complete name of the owner of the mark. Enter the complete business address of the owner of the mark. Identify the business structure of the registrant by checking the appropriate box. If a corporation, limited liability company, limited partnership or general partnership is the owner of the mark, please list the state of origination. Enter the names of the general partners, if registrant is a partnership. Enter the name and/or description of the Trademark or Service Mark as registered. Enter the Trademark or Service Mark registration number(s). Enter the original date of registration of the Trademark or Service Mark. Date, sign, and print the name of the person signing the renewal. 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. Enter the name and address of the person or company to receive the acknowledgment of the filing. Item 4. Item 5. Item 6. Item 7. Item 8. Item 9. American LegalNet, Inc. www.FormsWorkFlow.com