TMA SMA Filing Fee $50.00 William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 FORM MUST BE TYPED Trademark / Service Mark Assignment FORM MUST BE TYPED (General Laws Chapter 110H, Section 7) All information must be completed or this document will not be accepted for filing. (1) Registrant’s legal name and business address: a) Individual: ______________________________________________________________________________________ Last First Middle Business address: _________________________________________________________________________________ Number Street _________________________________________________________________________________ City State Zip or b) Business Organization:_____________________________________________________________________________ Business address: _________________________________________________________________________________ Number Street _________________________________________________________________________________ City State Zip (2) The mark is (complete one of the following): a) Words only - If the mark is only words, the words in the mark are (include type style if it is claimed as part of the mark): b) Design Only - If the mark is a design only, describe the design (include colors if they are claimed as part of the mark): c) Words and Design - State the words in the mark (include color and type style if they are claimed as part of the mark) and describe the design: American LegalNet, Inc. www.FormsWorkflow.com c110hs7 10/26/06 (3) For each class provide the number and class in which such goods or services fall (see attached classification schedule): (4) Provide the Massachusetts registration date and number: American LegalNet, Inc. www.FormsWorkflow.com The above does hereby assign said trademark or service mark and its registration to the following: a) Individual: ______________________________________________________________________________________ Last First Middle Business address: _________________________________________________________________________________ Number Street _________________________________________________________________________________ City State Zip or b) Business Organization:_____________________________________________________________________________ Business address: _________________________________________________________________________________ Number Street _________________________________________________________________________________ City State Zip Signed under penalty of perjury: By: __________________________________________ Assignor By: _______________________________________________ Assignee __________________________________________ Title _______________________________________________ Title American LegalNet, Inc. www.FormsWorkflow.com COMMONWEALTH OF MASSACHUSETTS William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 Trademark / Service Mark Assignment (General Laws Chapter 110H, Section 6) Registered with WILLIAM FRANCIS GALVIN Secretary of the Commonwealth on: ___________________________________________ , 20__________________ Trademark Section One Ashburton Place, Rm. 1717 Boston, MA 02108 Contact Information ________________________________________________________________ Name ________________________________________________________________ Mailing Address ________________________________________________________________ City/town State ZIP ________________________________________________________________ Telephone Email American LegalNet, Inc. www.FormsWorkflow.com