APPLICATION FOR RENEWAL OF TRADEMARK / SERVICE MARK State Form 2927 (R7 / 4-12) Approved by State Board of Accounts, 2006 FILING FEE: $ 10.00 CONNIE LAWSON SECRETARY OF STATE TRADEMARKS DIVISION 302 W. Washington St., Rm. E018 Indianapolis, IN 46204 Telephone: (317) 232-6540 INSTRUCTIONS: Required information can be found on original registration certificate. APPLICANT: OWNER OF TRADEMARK / SERVICE MARK Name of applicant Address (number and street, city, state, and ZIP code) Contact person (name and address of contact, if correspondence about this application should go to a party other than the signatory) Telephone number of contact person Telephone number of applicant ( ) ( TRADEMARK / SERVICE MARK INFORMATION File number of Trademark: (found on original certificate) Class number ) (Select only ONE class per form-found on original certificate.) Name and / or brief description of trademark / service mark Describe specific goods (classes 1-34) or services (classes 35-45) used in connection with the Mark. The Mark is used on / or in connecion with: VERIFICATION STATEMENT I, ____________________________________________________ affirm under penalty of perjury that (1) I am: (check box that applies) or the individual owner, a partner an officer (title) ________________________________ of applicant; (2) I have read this renewal application and its contents are true and complete to the best of my knowledge; (3) The Mark and all specimens provided are true and currently being used in commerce in the state of Indiana. Signature Date (month, day, year) REQUIREMENTS FOR SPECIMENS 1. Three (3) specimens must accompany this form. 2. The Specimen must be actual samples of how the Mark is currently being used in commerce. The specimens may be identical or they may be examples of three different uses showing the same Mark. 3. If the Mark is used on goods (Classes 1-34), examples of acceptable specimens are tags or labels which are attached to the goods, displays associated with the goods, or photographs of the goods showing use of the Mark on the goods themselves. Invoices, letterhead, business cards and brochures are generally not acceptable specimens for goods. 4. If the Mark is used for services (Classes 35-45), the specimens must show the Mark and include some clear reference to the type of services rendered under the Mark. Examples of acceptable specimens are signs, brochures about the services, advertisements, business cards or stationery, and photographs which show the Mark either as it is used in the rendering or advertising of the services. IMPORTANT RENEWAL APPLICATION INFORMATION 1. Renewal applications can be filed only by the trademark's owner of record. An assignment of ownership must be filed on the trademark before a renewal from a new owner can be accepted. 2. This application cannot be used to change or amend any information regarding the registration. 3. A trademark or service mark that is not renewed prior to its expiration date is abandoned and is no longer valid. There are no exceptions to this rule. 4. A renewal application may be filed within six months of expiration of registration. 5. Renewal of registration is effective for a term of five years. For the six months prior to the end of the five-year period, an additional renewal may be filed. FILING NOTES 1. A nonrefundable check or money order in the amount of $10.00, made to the order of Secretary of State of Indiana, must accompany this completed application. 2. A separate application (and $10.00 fee) must be filed for each Mark the applicant wishes to renew. 3. Please visit our website at www.sos.in.gov. American LegalNet, Inc. www.FormsWorkFlow.com