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