APPLICATION FOR ASSIGNMENT OF TRADEMARK/SERVICE MARKSTATE OF NEW MEXICOThis form may only be used to record the assignment of a trademark/service mark.1. Name of assignor: 2. Name of assignee: 3. Business address of assignee: 4. If assignee is a partnership, enter the state in which partnership is organized and the full and complete names of the general partners: 5. If assignee is a corporation or limited liability company, enter state of incorporation: 6. Name, address, and phone number of contact person for assignee: 7. File number of the trademark/service mark being assigned: 8. Name of trademark/service mark being assigned: 9. Date of assignment: 10. Person, mailing address and phone number if different from above: ( ) PhoneI hereby swear or affirm under penalty of perjury that the information provided is true, correct and complete and further that I registered in the State of New Mexico the trademark/service mark identified above, and transferred all rights andinterest in the trademark/service mark to the assignee named herein. By: Please Print Assignor222s Full Name Assignor Signature and TitleI hereby swear or affirm under penalty of perjury that I have adopted and am now using in the State of New Mexico thetrademark/service mark identified above. By: Please Print Assignee222s Full Name Assignee Signature and Title Submit application and $25.00 recording fee to: Office of the Secretary of State 325 Don Gaspar, Suite 301Santa Fe, New Mexico 87503Form TK4 (October 2003) American LegalNet, Inc. www.FormsWorkFlow.com