Document processing fee If document is filed on paper $150.00 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 Correction of Trademark Information of Record filed pursuant to §7-90-301, et seq. and §7-90-305 or §7-70-105 of the Colorado Revised Statutes (C.R.S) ID number: ___________ Document number: ___________ (of filed document to be corrected) 1. Trademark name: ______________________________________________________ 2. True name of registrant of trademark: (if an individual) ____________________ ______________ ______________ _____ (Last) (First) (Middle) (Suffix) OR (if a business organization) ______________________________________________________ Complete lines 3 - 10 as applicable to make a correction. Complete lines 11- 15 as applicable. You must complete line 16. 3. Correction of trademark description of record: (mark the appropriate box and fill in the blank) Words ONLY OR Words with OR stylized lettering* Words AND design* OR DESIGN ONLY* Trademark words or description: (If trademark contains no words, briefly describe the design) _____________________________________________________________ *Attach specimen or facsimile of trademark 4. Correction of name of current registrant of trademark of record: (if an individual): ____________________ ______________ ______________ _____ (Last) OR (if a business organization): CORRECT_TMSM (First) (Middle) (Suffix) ______________________________________________________ Page 1 of 3 Rev. 6/16/2005 American LegalNet, Inc. www.USCourtForms.com 5. Correction of address of current registrant of trademark of record: ______________________________________________________ (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (State) _______________________ ______________ (Province – if applicable) 6. Correction of service of process mailing address*: (Postal/Zip Code) (Country – if not US) ______________________________________________________ (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) *If this address is being deleted entirely, mark this box 7. Correction of class code of record: (Country – if not US) . _____________________ 8. Other correction(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. Correction of delayed effective date of record: and include an and include an attachment stating each ______________________ (only for filed documents that have not become effective) (mm/dd/yyyy) 10. Correction regarding unauthorized filed document (if the filed document should not have been filed, mark this box and include an attachment stating each incorrect statement that is corrected by the statement of correction). (only for filed documents that have become effective) 11. Corrections made in lines 3 - 10 are intended to update the entity’s current information OR Corrections made in lines 3 - 10 are intended for historical purposes only, and not to update the entity’s current information 12. If this statement of correction affects another record in the records of the Secretary of State, mark this and include an attachment stating the entity name, true name, trade name, or trademark and the box identification number of that record. 13. If this statement of correction affects this record’s status, mark this box 14. Revocation of a filed document that states a delayed effective date and has not yet become effective: ). (If applicable mark this box 15. Use of Restricted Words (if any of these terms are contained in an entity name, true name of an entity, trade name or trademark stated in this document, mark the applicable box): CORRECT_TMSM “bank” or “trust” or any derivative thereof “credit union” “savings and loan” “insurance”, “casualty”, “mutual”, or “surety” Page 2 of 3 Rev. 6/16/2005 American LegalNet, Inc. www.USCourtForms.com 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. 16. 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. CORRECT_TMSM Page 3 of 3 Rev. 6/16/2005 American LegalNet, Inc. www.USCourtForms.com