STATE OF MAINE MARK DISCLAIMER (To be filed with registration) A. I hereby disclaim the exclusive right to (describe portion of text or feature disclaimed): ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ In regards to the registration of: B. 1. TEXT - list word(s) to be protected, if any (if none, so indicate): ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 2. FEATURES - describe in detail the design to be protected, if any (if none, so indicate): ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ NOTE: Text and Features must be stated as appears on registration form. C. TYPE OF MARK: ("X" one box only) … … Service Mark - a mark used in connection with services applicant provides. … Combined Service/Trademark - a mark applied to goods and used in connection with services provided by the applicant. … Certification Mark - a mark used by an organization to certify the characteristics of goods or services provided by others. … D. Trademark - a mark applied to goods applicant manufactures or sells. Collective Mark - a mark used by members of a collective organization in connection with goods or services to indicate membership. I understand that I may not prevent another from using the disclaimed portion of this mark except as it might directly infringe on my rights as holder of this registered mark. Dated: ________________________________ ___________________________________________________ (applicant's signature) The execution of this certificate constitutes an oath or affirmation under the penalties of false swearing under 17-A MRSA §453. Submit completed form to: Secretary of State Division of Corporations, UCC and Commissions 101 State House Station, Augusta, ME 04333-0101 Telephone Inquiries: (207) 624-7752 Email Inquiries: CEC.Corporations@Maine.gov FORM NO. MARK-1A Rev. 10/29/2008 American LegalNet, Inc. www.FormsWorkflow.com