Document processing fee If document is filed on paper $10.00 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 Statement of Change of Trademark Information of Record filed pursuant to §7-90-301, et seq. and §7-90-305.5 or §7-70-105 of the Colorado Revised Statutes (C.R.S) ID number: ______________ 1. Trademark name: ______________________________________________________ 2. True name of registrant of trademark: (if an individual) ____________________ ______________ ______________ _____ (Last) OR (if a business organization) 3. Document number of filed document being changed: (First) (Middle) (Suffix) ______________________________________________________ __________________ 4. Change of true name of registrant of record: New true name of registrant of trademark: (if an individual): ____________________ ______________ ______________ _____ (Last) (First) (Middle) (Suffix) OR (if a business organization not an entity of record with the Colorado Secretary of State): ______________________________________________________ New address of registrant of trademark: ______________________________________________________ (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) (Country – if not US) 5. Change of business organization information of record: New business organization form: _____________________ New jurisdiction of formation: CHANGE_TMSM _____________________ Page 1 of 3 Rev. 8/15/2005 American LegalNet, Inc. www.USCourtForms.com 6. Change of class code of record: New class code: _____________________ 7. Change of service of process mailing address of record: New service of process mailing address: ______________________________________________________ (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) (Country – if not US) 8. Other change(s) not provided for above: If other information contained in the filed document is being changed, mark this box attachment stating the information to be changed and each such change. If other information is being added or deleted, mark this box addition or deletion. 9. (Optional) Delayed effective date: and include an and include an attachment stating each ______________________ (mm/dd/yyyy) 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. 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) _______________________ ______________ (Province – if applicable) (Postal/Zip Code) (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: CHANGE_TMSM Page 2 of 3 Rev. 8/15/2005 American LegalNet, Inc. www.USCourtForms.com 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. CHANGE_TMSM Page 3 of 3 Rev. 8/15/2005 American LegalNet, Inc. www.USCourtForms.com