COMMONWEALTH OF KENTUCKY ALISON LUNDERGAN GRIMES SECRETARY OF STATE Trademark/Service Mark Assignment _______________________________________________________________ being the owner of record in (Prior owner) the Office of the Secretary of State of the following registration (check box and fill in the mark as registered) trademark service mark described as follows: ____________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ bearing the certificate number _______________________________, does hereby assign, and transfer all right, title and interest in said mark with the goodwill of the business in which the mark is used, or that part of the goodwill of the business connected with the use of and symbolized by the mark to _______________________________________________________________________________________ (New owner) whose business address is: _______________________________________________________________________________________ (Street address) _____________________________, __________________________, ______________, ______________. (City) (County (State) (Zip code) If the Assignee is a corporation or limited liability company, the state of incorporation/organization is _________________. If the Assignee is a partnership, the state where the partnership is organized is ________________________ and the names of the general partners are ____________________________________________________. (Attach a continuation sheet, if necessary) The Assignor executes this assignment this _________ day of ____________________20 ______. ______________________________________ Signature ______________________________________ Type or Print Name and Title State of: ______________________ County of: ____________________ Subscribed and sworn to before me this __________ day of ______________________, 20 _______. ________________________________________________ Notary Public My Commission Expires: ____________________________ (01/12) American LegalNet, Inc. www.FormsWorkFlow.com 1 Instructions for completing the KY Trademark/Service Mark Assignment Form WHO MAY SIGN The assignment form must be verified and signed by the Assignor (prior owner), if an individual, or an officer or otherwise authorized agent on behalf of the Assignor. NOTE: The signature of the Assignor (or agent thereof) must be witnessed by a Notary Public. NUMBER OF COPIES Submit the original signed and notarized assignment form, no additional copies are necessary. FILING FEES The filing fee for an assignment is $5.00. Your check should be made payable to the Secretary of State. MAILING ADDRESS Secretary of State Trademark Division P. O. Box 718 Frankfort, KY 40602-0718 CERTIFICATE OF REGISTRATION Upon filing the assignment, the Secretary of State will issue in the name of the Assignee a new certificate for the remainder of the term of the registration or of the last renewal thereof. NOTE: An assignment filed with the Secretary of State does not extend the registration period. Please check your certificate after issuance for your expiration date. Contact Information For further information, call (502) 564-3490 Visit our website to review trademark/service mark FAQs and perform online searches: www.sos.ky.gov American LegalNet, Inc. www.FormsWorkFlow.com 2