APPLICATION TO AMEND TRADEMARK or SERVICE MARK REGISTRATION , Secretary of StateP.O. Box 94608 Lincoln, NE 68509 (404079http://www.sos.ne.gov Submit in Duplicate Registered Mark: Please mark the changes this amendment makes to the application for registration or the most recent assignment or amendment to the application and provide the new information (mark all that apply). Name of Owner Owners New Name: (If other than a Nebraska entity you must provide proof of name change, such as a file stamped copy of an amendment filed in another state or jurisdiction, marriage license, divorce decree, etc.) Address of Owner Owners New Address: Street Address City State Zip State of Incorporation or Organization of Owner New State Name: Classification Number New Classification Number (ONLY ONE, see classification list): (You may amend a classification number of a trademark or service mark that was filed before August 3, 2010 to comply with the requirements of the current regulations.) Signature of Owner State of County of Subscribed and sworn to before me this day of , 20 (seal) Notary Public Neb. Rev. Stat. 247 87-134 Filing Fee $5.00 Revised American LegalNet, Inc. www.FormsWorkFlow.com I. Classification of Goods 002 002002 002002002 002002 002 American LegalNet, Inc. www.FormsWorkFlow.com II. Classification of Services 002 002 002 002 002 002 002 002 002 002 002 002 002 002 Please Note: American LegalNet, Inc. www.FormsWorkFlow.com