Prepare, sign, and 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 RENEWAL of MARK 30-13-313, 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: Filing Fee: $20.00 per class number 24 Hour Priority Handling check box and Add $20.00 Folder ID Number: _____________ 1 Hour Expedite Handling check box and Add $100.00 The folder number begins with a "T" and may be referenced at https://www.mtsosfilings.gov. Make checks payable to Secretary of State. If the document is hand written, please print legibly or the application may be denied. 1. The mark to be renewed: __________________________________________________________________________________________________________ Note: Must be identical to the mark as currently registered with the Montana Secretary of State's office. 2. 3. Original identification numbered assigned by the Montana Secretary of State: _________________________________________ Attached is a specimen showing actual use of the mark on or in connection with the goods or services. (Required for all renewals whether it includes a design or is words only.) Class Numbers: ____________________________________________________________________________of service or goods. NOTE: If the original trademark registration was filed before July 1, 2003, the class number must be changed to agree with the new Class of Goods and Services. The list of new Class of Goods and Services can be viewed on line. If the original trademark registration was filed after July 1, 2003, the class number(s) must be identical to the class(es) originally registered. An additional renewal fee must be submitted for each class if you are renewing more than one class for this mark. The name and business mailing address of the person claiming ownership of the mark: Name: ____________________________________________________________________________________________________ Business mailing address: ____________________________________________________________________________________ City: _________________________________________ State: _____________________ Zip Code: _________________________ 6. 7. If a corporation, the state of incorporation: ______________________________________________________________________ If a partnership, the state in which the partnership is organized and the names of the general partners: State of organization: _______________________________________________________________________________________ Names of general partners: __________________________________________________________________________________ __________________________________________________________________________________________________________ 4. 5. sos.mt.gov/Business/Forms 74-Renewal_of_Mark Revised: 09/2016 American LegalNet, Inc. www.FormsWorkFlow.com 8. I, HEREBY SWEAR AND/OR AFFIRM, under penalty of law, including criminal prosecution, that the facts contained in this document are true, that the mark has been and is still in use. ___________________________________________________________________________ _____________________________ Signature of Applicant Date ____________________________________________________________ Printed Name ___________________________________________ Title (If a firm, an attorney-in-fact; if a partnership, a general partner; if a limited liability corporation, a managing manager or managing member; if a corporation, a presiding officer or chair of the board; if an association, a member) 9. Daytime Contact: Phone_________________________________ Email _____________________________________________ sos.mt.gov/Business/Forms 74-Renewal_of_Mark Revised: 09/2016 American LegalNet, Inc. www.FormsWorkFlow.com