COVER LETTER TO: Registration Section Division of Corporations SUBJECT:______________________________________________________________ (Name of Mark to be cancelled) The enclosed Application for the Cancellation of a Trademark and/or Service Mark and fee(s) are submitted for filing. Please return all correspondence concerning this matter to: ________________________________________________ (Contact Person) ________________________________________________ (Firm/Company) ________________________________________________ (Address) ________________________________________________ (City, State and Zip Code) For further information concerning this matter, please call: ____________________________________ at (________) _______________________ (Name of Contact Person) (Area Code and Daytime Telephone Number) Enclosed is a check for the following amount: $50.00 Filing Fee STREET ADDRESS: Registration Section Division of Corporations Clifton Building 2661 Executive Center Circle Tallahassee, FL 32301 CR2E077 (1/11) $102.50 Filing Fee and Certified Copy MAILING ADDRESS: Registration Section Division of Corporations P. O. Box 6327 Tallahassee, FL 32314 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR THE CANCELLATION OF A TRADEMARK AND/OR SERVICE MARK Pursuant to s. 495.101, Florida Statutes, the undersigned hereby submit(s) this application to cancel the following trademark and/or service mark registration: 1. Mark to be cancelled: _______________________________________________________________________ 2. Registration Number: _______________________________________________________________________ 3. Date of Registration: ________________________________________________________________________ 4. Signature of Owner(s): ___________________________________ Owner's Signature ___________________________________ Co-Owner's Signature, if any ___________________________________ ___________________________________ Typed or Printed Name of Owner ____________________________________ ____________________________________ Typed or Printed Name of Co-Owner Typed or Printed Name of Person Signing Above Typed or Printed Name of Person Signing Above STATE OF ____________________________ COUNTY OF __________________________ Sworn to and subscribed by me on n this _____ day of _______________, 20_____, (Name of Individual Signing) , personally appeared before me, who is/are personally known to me or whose identity (ies) I proved on the basis of ____________________________________ Notary Public's Signature (Seal) ____________________________________ Notary Public's Printed Name . My Commission Expires: ______________________ (Attach additional sheet if necessary) Filing Fee: Certified Copy (optional): $50.00 $52.50 American LegalNet, Inc. www.FormsWorkFlow.com