TMSM ­ 03 Rev. 10/02 New Jersey Division of Revenue APPLICATION TO ASSIGN A REGISTERED TRADE OR SERVICE MARK This form may be used by applicants seeking to reassign a registered State trade or service mark pursuant to NJSA 56. Applicants are responsible for strict adherence to all requirements as set forth in State law. 1. Trade/Service Mark Number: (as assigned by the State Treasurer and listed on the Certificate of Registration) 2. Owner Information: a. Name: (must match the name indicated on the Division of Revenue's records): b. Current Business Address: (must match the address indicated on the Division of Revenue's records) 4. Assignee Information: a. Name: b. Address: 5.Signatures: The mark is hereby assigned. _______________________________________ (Signature of Owner, or a Member of the Firm, or an Officer of the Corporation or Business Applying) _______________ (Date) _______________________________________ (Assignee) _______________ (Date) American LegalNet, Inc. www.USCourtForms.com Instructions for Form TMSM-03 Type or machine print all information except signatures and file the application in duplicate. Remittance/Fees: A check or money order signed and made payable to the NJ Division of Revenue must accompany the application. Base Filing Fee 1) $50.00 per filing (includes one classification) Premium Service Surcharges: 1) $15.00 additional per filing for expedited handling (8.5 business hour processing for items delivered over the counter) 2) $100.00 additional per filing for same day service (same day processing for items delivered over the counter) Addresses: Regular service (regular mail) NJ Division of Revenue Po Box 453 Trenton, NJ 08646-0453 Expedited and same day service ** NJ Division of Revenue 225 West State Street, 3rd Fl. Trenton, NJ 08608-1001 **Delivery by messenger or in person only; Do not use USPS overnight delivery. THIS FORM SERVES TO SIMPLY FILE WITH THE TREASURER and DOES NOT REPLACE THE NEED FOR COMPETENT LEGAL ADVICE. American LegalNet, Inc. www.USCourtForms.com