Document Processing Fee If document is on paper: If document is filed electronically: Fees are subject to change. $10.00 $ .99 For electronic filing and to obtain copies of filed documents visit www.sos.state.co.us Deliver paper documents to: Colorado Secretary of State Business Division 1560 Broadway, Suite 200 Denver, CO 80202-5169 Paper documents must be typed or machine printed. Instructions for completing Assignment of Trademark Use these instructions when completing an Assignment of Trademark pursuant to §7-70-105 and part 3 of Article 90 of Title 7 of the Colorado Revised Statutes (C.R.S.). Provide only information required or permitted to be included in the document by Colorado law. Information included in the document must be typewritten, in English and must state the name(s) and address(es) of at least one individual causing the document to be delivered for filing. The required form/coversheet must be used when filing the document. For legal authority, refer to §7-90-301 and §7-90-302, C.R.S. You may include additional information in an attachment to the form/coversheet. Any attachment becomes part of the document. If there is a conflict between information in the attachment and the form/coversheet, the information in the form/coversheet controls. Information provided in a case-sensitive format will be retrieved and displayed in the same format. Visit our Web site at www.sos.state.co.us and click on “Business Center” for a copy of a document after filing, Certificates of Good Standing, other electronic services, and other information. For answers to general filing questions consult the Frequently Asked Questions (FAQs), also on our Web site. Line-by-line Instructions: ID Number. The number assigned to the initial document that began the record in the records of the Colorado Secretary of State. This ID number is specific to the Colorado Secretary of State. It is not a state or federal tax number. The ID number is listed on the record’s “Information on File” page on our Web site. A record may be viewed by visiting our website at www.sos.state.co.us. Click on “Business Center”, then “Search Business Database”. This ID number must be indicated on all documents related to an existing record in the records of the Colorado Secretary of State. Document Number. The number assigned to a document filed in a record in the Business Division database at the Colorado Secretary of State’s office. Document numbers are listed on the History page of records on our website. A record may be reviewed by visiting our website at www.sos.state.co.us, and clicking on “Business Center”, then “Search Business Database”. Trademark Description. Indicate whether the trademark consists of words only, words with stylized lettering, words and design, or design only by marking the applicable box. If the trademark contains words, specify those words on the line provided. If the trademark consists of a design only and does not contain words, supply a description on the line provided. Trademarks that are words with stylized letters, a combination of words and design, or design only require that a specimen of the trademark be attached. Name of Current Registrant. List the name of the current registrant of the trademark and complete all applicable information in this section. Form of Entity. Indicate the form of the entity (examples include “corporation”, “limited liability company”, “partnership”). Jurisdiction of Formation. Indicate under which state’s or country’s laws the business organization is governed (where the entity was formed). Rev. 6/16/2004 1 of 2 Registrant Mailing Address. List the complete mailing address of the current registrant. Registrant Service of Process Mailing Address. If the registrant is not an individual who is a resident of Colorado and is a person not maintaining a registered agent pursuant to part 7 of article 90 of title 7, indicate the address to which service of process may be mailed. Name of Assignee. List the name of the assignee of the trademark and complete all applicable information in this section. Form of Entity. Indicate the form of the entity (examples include “corporation”, “limited liability company”, “partnership”). Jurisdiction of Formation. Indicate under which state’s or country’s laws the business organization is governed (where the entity was formed). Assignee Mailing Address. List the complete mailing address of the assignee. Assignee Service of Process Mailing Address. If the assignee is not an individual who is a resident of Colorado and is a person not maintaining a registered agent pursuant to part 7 of article 90 of title 7, indicate the address to which service of process may be mailed. Delayed Effective Date. The effective date of this document may be delayed up to 90 days after filing with the Colorado Secretary of State. The delayed effective date may also specify a particular time of day Mountain Time. If no time of day is specified, it defaults to close of business on that date. Close of business is 11:59:59 PM Mountain Time. For legal authority, refer to §7-90-304, C.R.S. Attachments. The written instrument(s) duly executed by the owner, by which the assignment of the trademark is made, must be attached. Notice. Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the individual's act and deed, or that the individual in good faith believes the document is the act and deed of the person on whose behalf the individual is causing the document to be delivered for filing, taken in conformity with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic statutes, and that the individual in good faith believes the facts stated in the document are true and the document complies with the requirements of that Part, the constituent documents, and the organic statutes. This perjury notice applies to each individual who causes this document to be delivered to the secretary of state, whether or not such individual is named in the document as one who has caused it to be delivered. Filing Information. State the name(s) and address(es) of the individual(s) causing this document to be delivered for filing. This information is required for the Colorado Secretary of State to deliver notice if the filing of the document is refused (§7-90-301, C.R.S.). The individual(s) listed will be held responsible for complying with the above notice. The document need not state the true name and address of more than one individual. However, if you wish to state the name and address of any additional individuals causing the document to be delivered for filing, mark this box ‫ ٱ‬and include an attachment stating the name and address of such individuals. Disclaimer. These instructions, and the related form, are not intended to provide legal, business or tax advice, and are offered as a public service without representation or warranty. While the related form is believed to satisfy minimum legal requirements as of its revision date, compliance with applicable law, as the same may be amended from time to time, remains the responsibility of the user of this form. Questions should be addressed to the user’s attorney. Rev. 6/16/2004 2 of 2 Document processing fee If document is filed on paper $125.00 If document is filed electronically Currently Not Available Fees & forms/cover sheets are subject to change. To file electronically, access instructions for this form/cover sheet and other information or print copies of filed documents, visit www.sos.state.co.us and select Business Center. Paper documents must be typewritten or machine printed. ABOVE SPACE FOR OFFICE USE ONLY Assignment of Trademark filed pursuant to §7-90-301, et seq. and §7-70-105 of the Colorado Revised Statutes (C.R.S.) ID number: ______________ Document number: ______________ (if different) 1. Trademark to be assigned: (mark the appropriate box and fill in the blank): Words ONLY OR Words with stylized lettering* OR Words AND OR design* DESIGN ONLY* Trademark words or description: (If trademark contains no words, briefly describe the design) _____________________________________________________________ 2. Name of current registrant: (if an individual): ____________________ ______________ ______________ _____ (Last) (First) (Middle) (Suffix) OR (if a business organization): ______________________________________________________ Form of entity: (if a business organization) ______________________________________________________ Jurisdiction of formation: (if a business organization) ______________________________________________________ 3. Registrant mailing address: ______________________________________________________ (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) (Country – if not US) 4. The registrant does not have an agent for service of process; service of process may be mailed to the following ______________________________________________________ address: (Complete if statement is true) (Street name and number or Post Office Box information) ______________________________________________________ ASGN_TMSM Page 1 of 3 Rev. 6/7/2006 __________________________ ____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) (Country – if not US) 5. Name of assignee: (if an individual): ____________________ ______________ ______________ _____ (Last) (First) (Middle) (Suffix) OR (if a business organization): ______________________________________________________ ID number: ______________ (if a business organization and if applicable) Form of entity: ______________________________________________________ (if a business organization) Jurisdiction of formation: ______________________________________________________ (if a business organization) 6. Assignee mailing address: ______________________________________________________ (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) (Country – if not US) 7. The assignee does not have an agent for service of process; service of process may be mailed to the following ______________________________________________________ address: (Complete if statement is true) (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) 8. (Optional) Delayed effective date: (Country – if not US) ______________ (mm/dd/yyyy) 9. Assignments must be by instruments in writing duly executed by the owner. Such instruments must be attached. Notice: Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the individual's act and deed, or that the individual in good faith believes the document is the act and deed of the person on whose behalf the individual is causing the document to be delivered for filing, taken in conformity with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic statutes, and that the individual in good faith believes the facts stated in the document are true and the document complies with the requirements of that Part, the constituent documents, and the organic statutes. This perjury notice applies to each individual who causes this document to be delivered to the secretary of state, whether or not such individual is named in the document as one who has caused it to be delivered. ASGN_TMSM Page 2 of 3 Rev. 6/7/2006 10. Name(s) and address(es) of the individual(s) causing the document to be delivered for filing: ____________________ ______________ ______________ _____ (Last) (First) (Middle) (Suffix) ______________________________________________________ (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) (Country – if not US) (The document need not state the true name and address of more than one individual. However, if you wish to state the name and address of any additional individuals causing the document to be delivered for filing, mark this box name and address of such individuals.) and include an attachment stating the Disclaimer: This form, and any related instructions, are not intended to provide legal, business or tax advice, and are offered as a public service without representation or warranty. While this form is believed to satisfy minimum legal requirements as of its revision date, compliance with applicable law, as the same may be amended from time to time, remains the responsibility of the user of this form. Questions should be addressed to the user’s attorney. ASGN_TMSM Page 3 of 3 Rev. 6/7/2006