Office of the Minnesota Secretary of State Trademark, Service Mark, Certification Mark or Collective Mark Minnesota Statutes, Chapter 333 Read the instructions before completing this form. Filing Fee: $70 for expedited service in-person, $50 if submitted by mail 1. You must include a sample of commercial use (See Instructions). 2. State the words or phrase to be registered: 3. Provide a written description of the logo design (if none, leave blank). Stylized letters are not a logo design: 4. Trade/Service Mark Classification Number (See instructions before completing this item): NOTE: A separate application and fee is required for each classification desired. 5. List the SPECIFIC goods or services within the above classification for which the mark is used: 6. How and where is the mark displayed on the goods or services listed in Item 4? 7. List the date on which this mark was first used in commerce by the applicant or their predecessor(s) in Minnesota: (Must have been used prior to registration) Month Day Year 8. Name and address of the individual or organization applying for this mark: Name Home Jurisdiction (for organizations only) Street Address City State Zip 9. I, the undersigned, certify that I am signing this document as the person whose signature is required, or as agent of the person(s) whose signature would be required who has authorized me to sign this document on his/her behalf, or in both capacities. I further certify that I have completed all required fields, and that the information in this document is true and correct and in compliance with the applicable chapter of Minnesota Statutes. I understand that by signing this document I am subject to the penalties of perjury as set forth in Section 609.48 as if I had signed this document under oath. Signature (Only one markholder or an authorized agent is required to sign) Print Name and Title American LegalNet, Inc. www.FormsWorkFlow.com Date Office of the Minnesota Secretary of State Trademark, Service Mark, Certification Mark or Collective Mark Minnesota Statutes, Chapter 333 Email Address for Official Notices Enter an email address to which the Secretary of State can forward official notices required by law and other notices: Check here to have your email address excluded from requests for bulk data, to the extent allowed by Minnesota law. List a name and daytime phone number of a person who can be contacted about this form: Contact Name Phone Number TrademarkapplicationRev.7/15/2013 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS File your business document online by visiting our website at www.sos.state.mn.us. Retain the original signed copy of this document for your records and submit a legible photocopy for filing with the Office of the Secretary of State. 1) You must submit one specimen or facsimile of the mark as you have actually used it in commerce. Copies are acceptable. A typewritten statement of the mark would not be acceptable, since it would not have been in use with the public. Acceptable examples would be a business card, letterhead, clipping from an advertisement, label, picture or copies of such materials. 2) State the words or phrase to be registered, if any. The words or phrase must be listed exactly as it appears on the specimens submitted with this application. A separate application is needed for each phrase to be registered. 3) Provide a written description of the logo design to be registered, if any. This description must depict the design as it appears on the accompanying specimen. Only one logo design is permitted per application. If none, leave blank. 4) Indicate the classification number under which this mark falls. A list of the international system of trade and service mark classifications is available from the Office of the Secretary of State. Leave blank if unknown and this office will fill it in. A separate application and fee is required for each classification in which you wish to register a mark. 5) State the SPECIFIC goods or services represented by the mark. DO NOT use indefinite terms, such as "accessories", "products," or the like. Use language that would be readily understandable to the general public. For example, "t-shirts" or "dry cleaning services". The identification of goods or services must NOT describe the mode of use of the mark, such as on labels, stationery, business cards, menus, signs or in advertising. If the applicant identifies the goods or services too broadly as, for example, "advertising and business," or just "products," or "services," the application will be returned. 6) State the way the mark appears on the goods, i.e., "on containers," "on tags or labels affixed to the goods", "by stamping it on the goods". 7) In order to register a mark in Minnesota, it must have been used commercially prior to registration. List the date the mark was first used in Minnesota. If it has not yet been used in Minnesota, you cannot register the mark with this office. 8) State the name and complete address of the applicant. If the applicant is an organization, list the home jurisdiction and the principal place of business in the home jurisdiction. 9) A signature of one markholder listed or an Authorized Agent (The signing party must indicate on the document that they are acting as the agent of the person(s) whose signature would be required and that they have been authorized to sign on behalf of that person(s).) is required. Include the date, printed name of the person signing, and the title of the signer. Email Address for Official Notices. This email address may be used to send annual renewal reminders and other important notices that may require action or response. Check the box if you wish to have your email address excluded from requests for bulk data, to the extent allowed by Minnesota law. List a name and daytime telephone number of a person who can be contacted about this form. Filing Fee: $70 for expedited service in-person, $50 if submitted by mail Payable to the MN Secretary of State Please submit all items together and mail to the address below: FILE IN-PERSON OR MAIL TO: Minnesota Secretary of State - Business Services Retirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St Paul, MN 55103 (Staffed 8 a.m. ­ 4 p.m., Monday - Friday, excluding holidays) Phone Lines: (9 a.m. - 4 p.m., M-F) Metro Area 651-296-2803; Greater MN 1-877-551-6767 All of the information on this form is public. Minnesota law requires certain information to be pro