IN S TRUCTIO N S ( FO R M TM 0 4) NO T E: T h i s f or m (F or m T M 0 4 ) i s on l y f o r c h a n gi n g t h e n a me and / o r a d d r e ss o f t h e r e g i str a n t o f a r e g i stered t r a de mark o r s e r v i c e mark. T h is f o r m may no t b e used to ass i gn o r t ra n sf e r o w ne rs h ip o f a r e g i stered mark. Use t h e ass i g n me n t f or m (F o rm T M 03) to c h a n ge t h e o w ne r o f a r e g ister e d mark from on e p e rs on / en t i ty to a differe n t pe rs on / en t it y . Li n e 1 : Enter t h e tra d e ma r k o r s e r vice ma r k reg i s trat i o n n um b er. Li n e 2 : Enter t h e n a me o f t h e ma r k as it ap p ears o n t h e r e c o r d s o f the S e creta r y o f St a t e o ff i c e. Li n e 3 : Enter t h e d ate o f re g i str a t i o n o f t h e tra de mark o r se r vice ma r k. Li n e 4. Enter t h e reg i s tra n n a me and b u si n ess a dd ress as it cu r rently a p p ears o n t h e r e c o r d s o f t h e Secreta r y o f St a o ff i c e. Li n e 5. C h eck and co m p le t e all th a t a pp ly. a. Registra n t N a me Cha n g e Enter t h e n e w n a me o f t h e reg i strant, and the effe c ti v e d ate o f the na m e ch ang e. S u b mit s upp o rti n g doc u ment a ti o n s h o wing t h e c h a ng e o f n a m e o f t h e reg i strant. b. Registra n t A d d r e ss Cha n g e Enter t h e n ew b u si ne ss a dd ress o f re g istra n t, n e w mai l i n g ad d ress , a nd / o r new secondary email address o f the r eg i s tra n t. Li n e 6. If re g istra n t i s an e n tit y , e n ter t h e st a te o r c o un t r y o f i n c o r p o r a ti o n /fo r m a ti o n / o r g a n i z atio n . Li n e 7. S ign , date, p ri n t t h e si g n er s n am e , and e n t er t h e tit l e o f t h e sig n er if a pp l i ca b le. Enter t h e si g n e mail ad d r e ss . A p p l i cati o n m u st be si gn ed b y t h e reg i strant o n ly. F o r a reg i strant t h at is an i nd iv i du al, the ap p l i cat i o n m u st b e si gn ed by t h a t i n d ivid u a l. For c o r p o r atio n s , ap p l i cat i o n m u st b e si gn ed by an a u t h o ri z ed o ff i cer o f the c o r p o r atio n . F o r ge n eral o r l i mited pa r tners h i p s, a p p l i cati o n m u st b e si gn ed b y a g eneral p a r tner. F o r L L C s , ap p l i cati o n m u st b e si gn ed by a ma n a g er o r m e m b er. F o r L L P s, a p p l i cati o n m u st b e si gn ed b y a p art n er. An att o r n ey m a y sign f o r t h e r e g istra n t b y inc lud i n g t h e s tat e ment "At t o r n e y f o r ." Mail the c o m p l eted ap p l i c a ti o n t o the ad d re s s at the t o p o f t h e ap p l i cati o n . If t h e name o f t h e r eg i strant is bei n g c h a ng ed ( Li n e 5a), su p p o rti n g doc u ment a ti o n showi n g t h e ch ang e o f n a me o f the r eg i strant m u st b e su b m i tted with the ap p l i cat i o n. There is no f ee to file an ap p l i cati o n t o ch ang e a r eg i s t ra n n a m e a n d / o r a dd re s s (Fo r m T M 04 ) . FO R M T M 0 4 I n s t ru c tio n s American LegalNet, Inc. www.FormsWorkFlow.com FORM TM04 (Rev 6/2019 ) OFFICE OF SECRETARY OF STATE CORPORATIONS DIVISION 2 Martin Luther King Jr. Dr. SE Suite 313 West Tower Atlanta, Georgia 30334 (404) 656 - 2817 http://sos.ga.gov/ Secretary of State TRADEMARK OR SERVICE MARK REGISTRANT NAME AND/OR ADDRESS CHANGE T HE UNDERSIGNED HEREB Y SUBMITS THIS APPLI CATION TO CHANGE THE NAME AND / OR ADDRESS OF THE REGISTRANT OF THE FOLLOWING G EORGIA TRADEMARK AND / OR SERVICE MARK REGI STRATION : 1. R EGISTRATION N UMBER : 2. N AME OF M ARK : 3. D ATE OF R EGISTRATION : 4. N AME OF R EGISTRANT ( BEFORE THE CHANGE ) : B USINESS A DDRESS : 5. C HECK AND COMPLETE AL L THAT APPLY : A . R EGISTRANT N AME C HANGE N EW N AME OF R EGISTRANT : D ATE NAME CHANGE EFFE CTIVE : B . R EGISTRANT A DDRESS C HANGE N EW B USINESS A DDRESS , IF APPLICABLE : N EW M AILING A DDRESS , IF APPLICABLE : N EW SECONDARY EMAIL ADDR ESS , IF APPLICABLE : 6. I F REGISTRANT IS AN E NTITY , LIST STATE OR COUNT RY OF INCORPORATION / FORMATI ON / ORGANIZATION : 7. I CERTIFY , UNDER THE PENALTY O F PERJURY , THAT I AM AUTHORIZED TO SI GN THIS APPLICATION , AND THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT . S IGNATURE OF R EGISTRANT : D ATE : P RINT N AME : T ITLE ( IF SIGNING FOR AN EN TITY ): E MAIL : Mail or d e li v er to the Secreta r y of Sta t e, at the above a dd r e s s, the foll o w i n g : ( 1) This completed application; and ( 2) Supporting documentation showing the change of name of the registrant, if applicable. F ILING F EE : $ 0 American LegalNet, Inc. www.FormsWorkFlow.com