Reference Business Regulation Article Title 1, Subtitle 4, Annotated Code of Maryland Print this form, complete it (can be filled out online) and mail it with a check or money order for $10.00 to: Trademark Division, Office of the Secretary of State, State House, Annapolis MD 21401. Please make checks payable to: Secretary of State For more information call (410) 974-5521. Whereas (name of assignor and state of incorporation)_____________________________ of (full address) has adopted, used and is using the mark which is registered with the Secretary of State, said mark having been granted Registration No. _______________ dated_______________ and, Whereas (name of assignee and state of incorporation) _____________________________ of (full address) is desirous of acquiring said mark and registration thereof: Now, therefore, for good and valuable consideration, receipt of which is hereby acknowledged, (name of assignor) _________________________________________________________ does hereby assign _________________________________________________________ (name of assignee) _________________________________________________________ right, title and interest in and to said mark, together with the good will of the business in which the mark is used (or that part of the good will of the business connected with the use of and symbolized by the mark) and the Registration No. _________________ thereof. Name of assignor: __________________________________________________________ By: ______________________________________________________________________ Date: ___________________ Trademark or Service Mark Assignment Form American LegalNet, Inc. www.FormsWorkFlow.com