OFFICE OF SECRETARY OF STATE CORPORATIONS DIVISION Suite 315, West Tower, 2 Martin Luther King Jr., Drive Atlanta, Georgia 30334-1530 (404) 656-2861 Trademark Search and Status Information on the Internet http://www.sos.state.ga.us/corporations/marksearch.htm KAREN HANDEL Secretary of State ASSIGNMENT FORM TRADEMARK OR SERVICE MARK Filing Fee $15.00 IN COMPLIANCE WITH THE REQUIREMENTS OF O.C.G.A. §10.1-446, THE UNDERSIGNED, HAVING ADOPTED AND USED A TRADEMARK OR SERVICE MARK IN THIS STATE FOR PURPOSES PROVIDED IN THE CODE CHAPTER, DOES HEREBY CERTIFY THE FOLLOWING: 1. _______________________________________________________________________________________________________ CURRENT REGISTERED OWNER (ASSIGNOR) 2. _______________________________________________________________________________________________________ PRINCIPAL BUSINESS ADDRESS 3. _______________________________________________________________________________________________________ ASSIGNEE IF A CORPORATION GIVE STATE OR COUNTRY OF INCORPORATION ______________________________________ a) 4. _______________________________________________________________________________________________________ PRINCIPAL BUSINESS ADDRESS 5. _______________________________________________________________________________________________________ DESCRIPTION OF MARK A) ______________________________________ REGISTRATION NUMBER B) ______________________________________ INITIAL REGISTRATION DATE C) ______________________________________ EXPIRATION DATE BE IT KNOWN FOR AND IN CONSIDERATION OF MONIES, AND/OR OTHER GOOD AND VALUABLE CONSIDERATION TO IT IN HAND PAID, THE RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED, SAID ASSIGNOR BY THESE PRESENTS DOES SELL, AND/OR ASSIGN, AND/OR TRANSFER UNTO SAID ASSIGNEE THE ENTIRE RIGHT TITLE AND INTEREST IN AND TO THE SAID MARK AND REGISTRATION THEREOF, TOGETHER WITH (THE GOOD WILL) OR (THAT PART OF THE GOOD WILL) OF THE BUSINESS CONNECTED WITH THE USE OF AND SYMBOLIZED BY THE MARK. SIGNATURE OF ASSIGNOR/OWNER ____________________________________________________ PRINT OR TYPE NAME ____________________________________________________ ____________________________________________________ OFFICIAL TITLE (IF SIGNING FOR A CORPORATION OR OTHER SIMILAR ENTITY) STATE OF ______________________________ COUNTY OF ______________________________ SWORN TO AND SUBSCRIBED BEFORE ME THIS ______ DAY OF ________________19, __________________ _________________________________________ NOTARY PUBLIC MY COMMISSION EXPIRES ______________________________________ American LegalNet, Inc. www.FormsWorkflow.com