Prepare, sign, submit with an original signature and filing fee. This is the minimum information required. STATE OF MONTANA (This space for Secretary of State use only) APPLICATION for REGISTRATION of MARK (Trademark or Service Mark) 30-13-311, MCA MAIL: LINDA McCULLOCH Secretary of State P.O. Box 202801 Helena, MT 59620-2801 (406) 444-3665 (406) 444-3976 sos.mt.gov PHONE: FAX: WEB SITE: Required Filing Fee: $20.00 per class Plus $20.00 per each additional class 24 Hour Priority Handling check box and Add $20.00 1 Hour Expedite Handling check box and Add $100.00 Make checks payable to Secretary of State. If the document is hand written, please print legibly or the application may be denied. 1. Check only one box and complete as requested. For either option, attach three specimens showing how the mark is being used (photocopies are acceptable). This mark is "words only" and does not include a design (e.g., words/numbers/letters only, no design) and the mark is: __________________________________________________________________________________________________________ This mark includes a design and a description of the mark is (describe the design and include words, letters, numbers if part of the design):____________________________________________________________________________________________________ __________________________________________________________________________________________________________ 2. The goods or services connected with the mark: __________________________________________________________________________________________________________ 3. The mode or manner in which the mark is used on or in connection with the goods or services (attach separate sheet if needed): __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ 4. Class Numbers: _____________________________________________________________________________________________ Identify the number of the classes that best describe the goods or services from the following online list: Class of Goods and Services . NOTE: An additional filing fee must accompany each class when registering multiple classes. The date the mark was first used by the applicant or a predecessor in business: (Note: Must complete both (a) and (b). Date first used anywhere must be the same or earlier than the date first used in Montana.) 5. (a) Date first used ANYWHERE:______________________________________________________________________________ (Month/Day/Year) Date first used in MONTANA: ____________________________________________________________________________ (Month/Day/Year) (b) sos.mt.gov/Business/Forms 73-Registration_of_Mark Revised: 07/2015 American LegalNet, Inc. www.FormsWorkFlow.com 6. The name and business mailing address of the applicant: Name: ____________________________________________________________________________________________________ Business mailing address: ____________________________________________________________________________________ City: _________________________________________ State: _____________________ Zip Code: _________________________ 7. The applicant is (check only one): An individual A firm A partnership State of organization: ___________________________________________ (Attach names of general partners) A limited liability company State of organization: ______________________________________________________________ A corporation State of incorporation: ________________________________________________________________________ An association A union Other organization I, HEREBY SWEAR AND/OR AFFIRM, under penalty of law, including criminal prosecution, that the applicant is the owner of the mark, that the mark is in use, and that, to the knowledge of the person verifying the application, no other person has registered the mark, either federally or in this state, or has the right to use the mark either in the identical form or in a form that so nearly resembles the mark as to be likely, when applied to the goods or services of the other person, to cause confusion, to cause mistake, or to deceive. _____________________________________________________________________________ ___________________________ Signature of Applicant Date ___________________________________________________________ Printed Name ____________________________________________ Title 8. 9. Daytime Contact: Phone_________________________________ Email _____________________________________________ sos.mt.gov/Business/Forms 73-Registration_of_Mark Revised: 07/2015 American LegalNet, Inc. www.FormsWorkFlow.com HELP SHEET: Application for Registration of Trademark or Service Mark Definition A trademark is any word, name, symbol, device, or any combination of words, names, symbols, or devices used by a person to identify and distinguish the goods of that person, including a unique product, from those manufactured or sold by others and to indicate the source of the goods, even if that source is unknown. A service mark is a mark used to identify a service rather than a product. A service mark differs from a trademark in that the mark is used on the advertising of service rather than on the packaging or delivery of the service. When registering a service mark you use the same form as the trademark. Item 1 Check only one box and complete by providing the description of your mark and attach the three (3) specimens showing how the mark is being used. If you checked words only, you must provide the letters, words and/or numbers of the mark. The three (3) specimens you submit must reflect words only. A design such as a picture or graphics appearing with the words will result in the application being returned for correction since it appears a design accompanies the words. If you only have specimens of the mark which contain other words or designs that are not part of the mark, you will need to clearly mark each specimen with "words only/no design" or the application may be returned for clarification. If the words reflected on your specimens are themselves a design, the application will be returned for correction since your mark appears to have a specific design. If you checked that the mark has a design, you must include any letters, words, or numbers of the mark and describe any designs (buildings, mountains, clouds, people, etc.) that are part of the mark being registered. Appl