TRADEMARK or SERVICE MARK APPLICATION , Secretary of State P.O. Box 94608 Lincoln, NE 68509 (402)471-4079http://www.sos.ne.gov Submit in Duplicate Applicant: Address: Street Address City State Zip Applicant is a: Corporation Limited Liability Company Limited Liability Partnership Limited Partnership Partnership Sole Proprietorship Other (Specify) If other than a sole proprietorship, state under whose laws the entity was formed If partnership, the names of the general partners Description of the Mark to be registered: Identify the goods or services on or in connection with which the mark is used: Classification Number (ONLY ONE, see classification list) Identify the mode or manner in which the mark is used: a.For goods, placed on: the goods or other containers associated displays tags labels documents associated with the goods or their saleb.For services, used or displayed: in the sale or advertising of servicesDate of first use of the Mark by applicant: a.Anywhereb.In NebraskaHas the mark been filed in the United States Patent and Trademark Office yes no If so, provide the filing date, serial number, and status of application Oath or Affirmation State of County of The applicant does hereby state and affirm that the applicant is the owner of the mark, the mark is in use, to the applicant's knowledge no other person has registered, either federally or in this state, or has the right to use such mark either in identical form or in such a near resemblance when applied to the good or services of such other person as to cause confusion, mistake, or to deceive. Signature of Applicant Official Capacity of Applicant Subscribed and sworn to before me this day of , 20 (seal) Notary Public Submit THREE examples of the mark as actually used FilingFeeRevised eb. Rev. Stat. 247 87-130-247 87-133 American LegalNet, Inc. www.FormsWorkFlow.com Classifications 7/15/10 1 I.Classification of Goods 1.Chemicals used in industry, science and photography, as well as in agriculture, horticulture and forestry;unprocessed artificial resins; unprocessed plastics; manures; fire extinguishing compositions; tempering andsoldering preparations; chemical substances for preserving foodstuffs; tanning substances; adhesives used inindustry.2.Paints, varnishes, lacquers; preservatives against rust and against deterioration of wood; colorants; mordants; rawnatural resins; metals in foil and powder form for painters, decorators, printers and artists.3.Bleaching preparations and other substances for laundry use; cleaning, polishing, scouring and abrasivepreparations; soaps; perfumery, essential oils, cosmetics, hair lotions; dentifrices.4.Industrial oils and greases; lubricants; dust absorbing, wetting and binding compositions; fuels (including motorspirit) and illuminants; candles and wicks for lighting.5.Pharmaceutical and veterinary preparations, sanitary preparations for medical purposes; dietetic substancesadapted for medical use, food for babies; plasters, materials for dressings; material for stopping teeth, dental wax;disinfectants; preparations for destroying vermin; fungicides, herbicides.6.Common metals and their alloys; metal building materials; transportable buildings of metal; materials of metal for railway tracks; non- electric cables and wires of common metal; ironmongery, smallitems of metal hardware; pipes and tubes of metal; safes; goods of common metal not included in other classes; ores. 7.Machines and machine tools; motors and engines (except for land vehicles); machine coupling and transmissioncomponents (except for land vehicles); agricultural implements other than hand-operated; incubators for eggs.8.Hand tools and implements (hand-operated); cutlery; side arms; razors. 9.Scientific, nautical, surveying, photographic, cinematographic, optical, weighing, measuring, signalling, checking(supervision), life-saving and teaching apparatus and instruments; apparatus and instruments for conducting,switching, transforming, accumulating, regulating or controlling electricity; apparatus for recording, transmission orreproduction of sound or images; magnetic data carriers, recording discs; automatic vending machines andmechanisms for coin- operated apparatus; cash registers, calculating machines, data processing equipment andcomputers; fire extinguishing apparatus. 10.Surgical, medical, dental, and veterinary apparatus and instruments, artificial limbs, eyes, and teeth; orthopedicarticles; suture materials.11.Apparatus for lighting, heating, steam generating, cooking, refrigerating, drying, ventilating, water supply, andsanitary purposes.12.Vehicles; apparatus for locomotion by land, air, or water.13.Firearms; ammunition and projectiles; explosives; fireworks.14.Precious metals and their alloys and goods in precious metals or coated therewith, not included in other classes;jewelry, precious stones; horological and chronometric instruments.15.Musical instruments.16.Paper, cardboard and goods made from these materials, not included in other classes; printed matter;bookbinding material; photographs; stationery; adhesives for stationery or household purposes; artists' materials;paint brushes; typewriters and office requisites (except furniture); instructional and teaching material (exceptapparatus); plastic materials for packaging (not included in other classes); printers' type; printing blocks.17.Rubber, gutta-percha, gum, asbestos, mica and goods made from these materials and not included in otherclasses; plastics in extruded form for use in manufacture; packing, stopping and insulating materials; flexible pipes,not of metal.18.Leather and imitations of leather, and goods made of these materials and not included in other classes; animalskins, hides; trunks and travelling bags; umbrellas, parasols and walking sticks; whips, harness and saddlery. 19.Building materials (non-metallic); non- metallic rigid pipes for building; asphalt, pitch and bitumen; non- metallictransportable buildings; monuments, not of metal. 20.Furniture, mirrors, picture frames; goods (not included in other classes) of wood, cork,reed, cane, wicker, horn, bone, ivory, whalebone, shell, amber, mother-of-pearl, meerschaum and substitutes for allthese materials, or of plastics.21.Household or kitchen utensils and containers; combs and sponges; brushes (except paint brushes); brush-makingmaterials; articles for cleaning purposes; steelwool; unworked or semi-worked glass (except glass used in building);glassware, porcelain and earthenware not included in other classes.22.Ropes, string, nets, tents, awnings, tarpaulins, sails, sacks and bags (not included in other classes); padding andstuffing materials (except of rubber or plastics); raw fibrous textile materials.23.Yarns and threads, for textile use. American LegalNet, Inc. www.FormsWorkFlow.com Classifications 7/15/10 2 24.Textiles and textile goods, not included in other classes; beds and table covers.25.Clothing, footwear, headgear.26.Lace and embroidery, ribbons and braid; buttons, hooks and eyes, pins and needles; artificial flowers.27.Carpets, rugs, mats and matting, linoleum and other materials for covering existing floors; wall hangings (non-textile).28.Games and playthings; gymnastic and sporting articles not included in other classes; decorations for Christmastrees.29.Meat, fish, poultry and game; meat extracts; preserved, dried and cooked fruits and vegetables; jellies, jams,compotes; eggs, milk and milk products; edible oils and fats.30.Coffee, tea, cocoa, sugar, rice, tapioca, sago, artificial coffee; flour and preparations made from cereals, bread,pastry and confectionery, ices; honey, treacle; yeast, baking-powder; salt, mustard; vinegar, sauces (condiments);spices; ice.31.Agricultural, horticultural and forestry products and grains not included in other classes; live animals; freshfruits and vegetables; seeds, natural plants and flowers; foodstuffs for animals; malt.32.Beers; mineral and aerated waters and other nonalcoholic drinks; fruit drinks and fruit juices; syrups and otherpreparations for making beverages.33.Alcoholic beverages (except beers).34.Tobacco; smokers' articles; matches. II.Classification of Services 35.Advertising;