Secretary of State APPLICATION TO REGISTER TRADE NAMETRADEMARK OR SERVICE MARK (Pursuant to R.S.f 1950, Title 51, Chapter 1, Part VI as amended) Enclose $75 filing fee Return to: Commercial Division Make remittance payable toSecretary of StateDo Not Send Cash P.O. Box 94125Baton Rouge, LA 70804-9125(225) 925-4704www.sos.la.gov STATE OF PARISH/COUNTY OFCheck One:( ) Trade Name ( ) Trademark ( ) Service MarkCheck One:( ) Original Filing ( ) Renewal1.Name of person(s), Corporation, Limited Liability Company or Partnership applying for registration: If applicant is a corporation, list state of incorporation:Full street address and P.O. Box address, city, state, and zip of applicant: 4.Name of trade name, trademark or service mark to be registered. If logo is included, please describe. If the LOGO of your trade name, trademark or service mark is part of your registration, attach copies of design. 5.Type of business or list of goods or services to which the trade name, trademark or service mark is applied:6.Enter class(es) in which trademark or service mark is registered:7.Date trade name, trademark or service mark first used by applicantMonth, Day, Year8.Date trade name, trademark or service mark first used in LouisianaMonth, Day, Year I, the applicant, am the owner of the trade name, trademark or service mark sought to be registered and no other person, firm, association, union or corporation has the right to such use in such class, either in the identical form hereinabove described, or in any such resemblance thereto as may be calculated to deceive, and the facsimiles or counterparts herein filed are true and correct. Sworn to and subscribed before me, the undersigned Notary Public, on this date: The below named person swears that he is the applicant, or an authorized representative of the applicant, named in the foregoing application, and that the facts alleged in said application are true.Applicant or Authorized RepresentativeNotary SignatureTitle SS309 Rev. (see instructions on back) (Class list on reverse side. There is a $75 registration fee for each class number registered.)NOTARY NAME MUST BE TYPED OR PRINTED WITH NOTARY # American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS1.Trade Name - a word or group of words, name, symbol, device or any combination thereof used by a person to identify his business, vocationor occupation and distinguish it from the business, vocation or occupation of others. Trademark - any word, name, symbol, device or anycombination thereof adopted and used by a person to identify goods, made or sold, and to distinguish them from goods made or sold by others.Service Mark - a mark used in the sale or advertising of services to identify the services of one person and distinguish them from the services ofothers.2.Fill in the full name of the individual(s), corporation, partnership or limited liability company who is the owner of the trade name, trademark or servicemark being registered.3.Give full municipal and mailing address of the person(s) listed in No. 2.4.List the trade name, trademark or service mark exactly as you intend to use it in your business. If a logo is included, please describe.5.Describe the type of business, such as 223restaurant224 or 223retail grocery store224 etc. If you are registering a trademark or service mark, list goods orservices to which the name is applied, such as 223cosmetics224, 223baker goods224, 223fishing equipment224, etc.6.No. 6 applies only to trademarks and service marks. Write the class number(s) under item 6. Check the list of classes set out below which describethe category of goods (trademarks only) or services (service marks only) being registered. If goods or services are registered in more than oneclass, you must pay a registration fee of $75 for each class registered.7.List the month, day and year when you first started using the trade name, trademark or service mark in business.8.List the month, day and year when you first started using the trade name, trademark or service mark in Louisiana. The trade name, trademark orservice mark must actually be in use on the date of this application. If you have not started actual use of the trade name, trademark or service mark,you can reserve the trade name, trademark or service mark for 120 days by sending a letter and $25 fee to the Secretary of State asking that it bereserved.9.The affidavit must be notarized. Show the name of the applicant, the name of the person authorized to make the application and his title. Theapplication must be signed by the applicant or the designated authorized representative.NOTE: The certificate of registration shall be issued if the Secretary of State finds that the trade name is distinguishable from or not the same as a trade name, limited liability company name, or corporate name already in use in this state, or that the trademark or service mark is distinguishable from or not the same as a trademark or service mark already in use in this state which is registered in the same class. The said classes are as follows:A.Goods (Trade Marks) 1.Chemicals16.Paper goods & printed matter31.Natural agricultural products2.Paints17.Rubber goods32.Light beverages3.Cosmetics & cleaning preparations18.Leather goods33.Wines and spirits4.Lubricants & fuels19.Nonmetallic building materials34.Smokers222 articles5.Pharmaceuticals20.Furniture & articles not otherwise classified35. Miscellaneous6.Metal goods21.House wares & glassB.Services (Service Marks) 7.Machinery22.Cordage & fibers8.Hand tools23.Yarns & threads9.Electrical & scientific apparatus24.Fabrics10.Medical apparatus25.Clothing11.Environmental control apparatus26.Fancy goods12.Vehicles27.Floor coverings13.Firearms28.Toys & sporting goods14.Jewelry29.Meats & processed foods42.Miscellaneous36.Insurance & financial37.Construction & repair38.Communication39.Transportation & storage40.Material treatment41.Education & entertainment43.Advertising and business15.Musical instruments30.Staple foodsNOTE: Our System stores logo registration documents in black-and-white only. Registrations submitted with full-color or grayscale logo graphics will be rejected. You must provide a black-and-white PDF of the logo with supporting text that sufficiently describes the unique elements of the logo. Rev. 0 American LegalNet, Inc. www.FormsWorkFlow.com