APPLICATION FOR REGISTRATION OF TRADEMARK/SERVICE MARK STATE OF NEW MEXICO Complete all items on the application. The application must be typed or printed in black ink and signed by an individual applicant, general partner, or officer of a corporation or an association. Enclose three different specimens of the mark and $25.00 for each class code plus an application fee of $25.00. 1. Name of applicant: 2. Business Address: 3. If applicant is a corporation or limited liability company, enter state of incorporation: 4. If applicant is a partnership, enter the state in which partnership is organizedand the full and complete names of the general partners: 5. Name of trademark/service mark being registered: 6. State the manner in which the mark will be used on or in connection with goods or services (i.e. on foods, on labels or tags, on displays, on signs or letterheads, in advertising materials, on business cards, etc.): 7. Describe in exact detail the mark to be registered: 8. Identify the place(s) of distribution of products in New Mexico or physical location where services are being rendered and available to be rendered in New Mexico (Not a P.O. Box): 9. Month, day, year of first use of trademark/service mark anywhere: MUST BE IN USE PRIOR TO REGISTRATION 10. Month, day, year of first use of trademark/service mark in New Mexico: MUST BE IN USE PRIOR TO REGISTRATION 11. Class code(s) in which above particular goods or services fall. 12. Describe the kind(s) of goods or services in each class which the trademark/service mark is used to identify: 13. Contact person and mailing address, if different from above: I hereby swear or affirm under penalty of perjury that the information provided is true, correct and complete and further that, I, or the person or entity I represent, own and use in the State of New Mexico the trademark/service mark identified above and to the best of my knowledge no other person has registered, either federally or in this state, or has the right to use the mark either in its identical form or in near resemblance thereto as to be likely, when applied to the goods or services of the other person, to cause confusion, mistake, or to deceive. By: Applicant Signature Title Date By: ( ) Please Print Applicant222s Full Name Phone Number Submit application, specimens and fees to: Office of the Secretary of State 325 Don Gaspar, Suite 301 Santa Fe, New Mexico 87503 Form TK1 (October 2003) American LegalNet, Inc. www.FormsWorkFlow.com