Filing Fee $10.00 for each class affected MARK STATE OF MAINE APPLICATION FOR AMENDMENT Deputy Secretary of State A True Copy When Attested By Signature Pursuant to 10 MRSA §1525-A, the undersigned hereby applies to the Secretary of State of Maine to amend the following mark: Deputy Secretary of State CAREFULLY READ ALL OF THE INSTRUCTIONS BEFORE YOU COMPLETE THIS FORM. A. B. CHARTER NUMBER (if known) ____________________ Amendments to TEXT and FEATURES of the mark are NOT permitted. 1. TEXT - list word(s) protected in the original registration, if any (if none, so indicate): ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 2. FEATURES - describe in detail the design protected in the original registration, if any (if none, so indicate): ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ C. TYPE OF MARK: ___________________________ The type of mark indicated represents an amendment from that appearing on the original registration, ! yes ! no. D. Complete this section ONLY if you are adding new classes or deleting old classes. CLASS NUMBER: __________ ! Added or ! Deleted (Complete for each class affected.) For each NEW class added, please complete the following: DESCRIBE goods manufactured or sold and/or the service that is provided: ______________________________________________________________________________________________________ _________________________________________________________________________________________________________ DESCRIBE manner in which mark is applied to the goods or used to promote their sale and/or the manner in which the mark is used in connection with the service: _________________________________________________________________________________________________________ ______________________________________________________________________________________________________ ! Attach additional pages, if necessary. American LegalNet, Inc. www.FormsWorkFlow.com E. I, ______________________________________________________________________________________________ believe (Print/Type Name and Capacity) ______________________________________________________________________________________________________ ("Myself", Firm, Association or Corporate Name) to be the owner of the accompanying mark and that "no other person to the best of my knowledge and belief has the right to use the mark in this state as a mark or as a trade name or as a corporate name either in the identical form thereof or in such near resemblance thereto as to be likely, when applied to the goods or services of the other person, to cause confusion or to cause mistake or to deceive." (10 MRSA §1522.2.D) ______________________________________________________________________________________________________ Signature of Applicant (Individual, Corporate or Association Officer) ______________________________________________________________________________________________________ (Mailing Address, City, State and Zip Code) F. Applicant is a (an) ! association ! individual ! union ! general partnership ! limited partnership ! corporation ! other __________________________________________________________ (Explain) If a corporation, limited partnership, limited liability company or limited liability partnership the state of incorporation/organization is _____________________________ and the date of incorporation/organization is ________________________ G. Date of this application ____________________ You MUST submit THREE (3) samples of the mark text and/or design with this application. If the mark is to be protected in color, all the samples must be in the appropriate colors. NOTE: Samples may be 3 of the same item, i.e. business cards, letterhead, etc. THE EXECUTION OF AN APPLICATION CONTAINING FALSE STATEMENTS WHICH ONE DOES NOT BELIEVE TO BE TRUE IS PUNISHABLE AS A CLASS D CRIME ACCORDING TO THE MAINE CRIMINAL CODE, 17-A MRSA §453, "UNSWORN FALSIFICATION". SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MARK-3 Rev. 4/16/2001 TEL. (207) 624-7752 American LegalNet, Inc. www.FormsWorkFlow.com Filer Contact Cover Letter To: Department of the Secretary of State Division of Corporations, UCC and Commissions 101 State House Station Augusta, ME 04333-0101 Tel. (207) 624-7752 Name of Entity (s): _______________________________________________________________________ _______________________________________________________________________ List type of filing(s) enclosed (i.e. Articles of Incorporation, Articles of Merger, Articles of Amendment, Certificate of Correction, etc.) Attach additional pages as needed. ________________________________________________________________________ ________________________________________________________________________ Special handling request(s): (check all that apply) Hold for pick up Expedited filing - 24 hour service ($50 additional filing fee per entity, per service) Expedited filing - Immediate service ($100 additional filing fee per entity, per service) Total filing fee(s) enclosed: $ ________________ Contact Information ­ questions regarding the above filing(s), please call or email: (failure to provide a contact name and telephone number or email address will result in the return of the erroneous filing (s) by the Secretary of State's office) ___________________________________ (Name of contact person) ___________________________________ (Daytime telephone number) ____________________________________________________ (Email address) The enclosed filing(s) and fee(s) are submitted for filing. Please return the attested copy to the following address: ______________________________________________________________________________ (Name of attested recipient) _____________________________________________________________________________________________ (Firm or Company) _____________________________________________________________________________________________ (Mailing Address) _____________________________________________________________________________________________ (City, State & Zip) American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING THE APPLICATION