APPLICATION FOR REGISTRATION OF ASSIGNMENT OF TRADEMARK-SERVICE MARK STATE OF IDAHO The assignor named herein states that he has heretofore registered in the State of Idaho the trademark-service mark identified below. The assignor further states that he has transferred all right and interest in the trademark-service mark to the assignee. The assignee states that he has adopted and is now using in the State of Idaho the trademark-service mark identified below. Pursuant to Section 48-507, Idaho Code, the undersigned hereby applies for the assignment registration of its trademark/service mark. 1. Name of assignor: ______________________________________________________________ 2. Name of assignee:______________________________________________________________ 3. Business address of assignee: ____________________________________________________ 4. If assignee is a partnership, name the general partners: ________________________________ _____________________________________________________________________________ 5. If assignee is a corporation, give state of incorporation: _________________________________ 6. The exact registered trademark-service mark assigned is described in detail as follows: _______ _____________________________________________________________________________ _____________________________________________________________________________ 7. The registration number and date of the registered trademark-service mark assigned are: No. ________________ Date_______________________________________________________ 8. Number of class in which above particular goods or services fall: _________________________ 9. Date of assignment: _____________________________________________________________ 10.Person and mailing address if different from above: ____________________________________ Phone(____) __________ ? ________________________________________ Assignor ? _____________________________________ Assignee Filing Office Use Only Submit Application and $30.00 filing fee to: SECRETARY OF STATE Trademark Division 450 N 4th Jefferson, Room 203 700 West Street PO Box 83720 P.O. Box 83720 Boise ID 83720-0080 83720-0080 k:\TMARKS\ASSIGNMT.PM6 TM#OTHER#### American LegalNet, Inc. www.FormsWorkflow.com