PAUL D. PATE Secretary of State State of Iowa STATE OF _____________________________ ) ) SS COUNTY OF ___________________________ ) Assignment of Registration of Mark Whereas ___________________________________ of __________________________________ in the City of _______________________________State of _________________________ , has adopted, used and is using the mark which is registered with the Secretary of State under Registration No _____________________ , a copy of which is attached hereto, dated the ________ day of __________________ , _______ and, 7 8 6 5 3 4 1 2 Whereas ___________________________________ of __________________________________ , in the City of ______________________________State of _________________________ , is desirous of acquiring said mark and registration thereof; 9 10 Now, therefore, for good and valuable consideration, receipt of which is hereby acknowledged, 1 7 said _______________________________ does hereby assign unto __________________________ all right, title, and interest in and to said mark, together with the good will of the business in which the mark is used (or that part of the good will of the business connected with the use of and symbolized by the mark) and the Registration No ________________________thereof. 5 By: ___________________________________________________ Assignor Subscribed and Sworn to before me this _______________ day of ________________________ 19 _____ . ______________________________________________________ Notary Public 635_0001 1/15 American LegalNet, Inc. www.FormsWorkFlow.com PAUL D. PATE Secretary of State State of Iowa INSTRUCTIONS for Assignment of Registration of Mark IT IS IMPORTANT that you read and understand these instructions before you begin to complete the assignment form. Failure to complete the form correctly or to provide all the requested information will result in the assignment being returned. If you have any questions, contact the secretary of state's office at (515) 281-5204. 1. All items must be completed before the assignment will be considered. Other documents or materials may be attached to the application. In such cases, the material or documents should be referenced to the form and clearly marked for ease of identification. ITEM 1 ITEM 2 ITEM 3 ITEM 4 ITEM 5 ITEM 6 ITEM 7 ITEM 8 ITEM 9 Insert the name of the party in whose name the trademark certificate is now held, who desires to assign the trade mark (the assignor). Insert the street address of the party identified in #1. Insert the city name for the address in #2. Insert the name of the state in which the city identified in #3 is located. Insert the trademark registration number found in the upper left corner of the trademark certificate under the heading "secretary of state." Example: 5480TM-000128114. Insert the date the trademark certificate was issued; located on the trademark certificate. Insert the name of the party to whom the trademark will be assigned (the assignee). Insert the street address of the party identified in #7. Insert the city name for the address in #8. ITEM 10 Insert the name of the state in which the city in #9 is located. 2. A copy of the trademark certificate must be attached to the assignment. If you do not have a copy, one may be obtained by calling 515-281-5204. 3. The assignment must be signed by the person in whose name the trademark certificate is issued or the duly appointed representative of the person, and must be notarized. NOTES: 1. The filing fee is $5.00. Make checks payable to SECRETARY OF STATE 2. The information you provide will be open to public inspection under Iowa Code chapter 22.11. SECRETARY OF STATE Business Services Division Lucas Building 1st Floor , Des Moines, IA 50319 Phone: (515) 281-5204 FAX: (515) 242-5953 Website: www.sos.iowa.gov American LegalNet, Inc. www.FormsWorkFlow.com