Filing Fee $10.00 MARK STATE OF MAINE _____________________ Deputy Secretary of State VOLUNTARY CANCELLATION OF REGISTRATION OF MARK A True Copy When Attested By Signature _____________________ Deputy Secretary of State Pursuant to 10 MRSA §1527.1B, the undersigned hereby applies to the Secretary of State of Maine to voluntarily cancel the following mark registration: A: Charter Number (if known): ____________________________________________ B: 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: The mark registration is voluntarily cancelled upon the filing of this request. DATED _________________________ *By ____________________________________________________ (signature of registrant or assignee of record) ____________________________________________________ (type or print name and capacity) * This document MUST be signed by the registrant OR the assignee of record. (10 MRSA §1527.1B) Please remit your payment made payable to the Maine Secretary of State. The execution of this application 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 American LegalNet, Inc. www.FormsWorkFlow.com Form No. MARK-6 9/16/2011 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