Prepare, sign, submit with an original signature and filing fee This is the minimum information required STATE OF MONTANA (This space for use by the Secretary of State only) STATEMENT of CHANGE of OWNERSHIP for TRADEMARK or SERVICE MARK MAIL: BRAD JOHNSON PHONE: FAX: WEB SITE: Secretary of State P.O. Box 202801 Helena, MT 59620-2801 (406)444-3665 (406)444-3976 sos.mt.gov Filing Fee: $20.00 24 Hour Priority Filing Add $20.00 1 Hour Expedite Filing Add $100.00 Whereas (Person to whom the mark was issued.) of , (Address) (City, state, zip) registered in the Office of Secretary of State of the State of Montana, the mark, known as: (Name of mark) Under Registration No. dated ,and Whereas (Person who is the applicant or registrant.) of (Address) (City, state, zip) Has acquired said mark and is one of the following: An individual. A corporation. Identify name of state where incorporated. An association. List names of members and state of organization. A partnership. List the names of partners and state of organization. A limited liability company. Identify the state of organization. A limited liability partnership. Identify the state of organization. A limited partnership. Identify the state of organization. PLEASE NOTE: BOTH SIGNATURE LINES BELOW MUST BE COMPLETED The person or entity to whom the mark was issued states under penalty of perjury, that the information contained in this Statement of Change of Ownership of Trademark or Service Mark is true and correct. Signature Must be signed by person or entity official to whom the mark was issued. Date The person or entity that is the applicant/registrant states under penalty of law, which the information contained in this Statement of Change of Ownership of Trademark or Service Mark, is true and correct. Signature Must be signed by person or entity official who is applicant or registrant. Date There are important legal and accounting implications with respect to this corporate action. Suitable legal and accounting advice should be secured before submission. The Secretary of State’s office encourages that such advice be sought prior to filling out forms to be sure that you understand the terms and procedures. All information provided will be made available on the Secretary of State’s web site or upon request. P:\Forms\trademark\73-Trademark_or_Service_Mark_Statement_of_Change_of_Ownership.doc Revised: 9/1/2006 American LegalNet, Inc. www.FormsWorkflow.com