APPLICATION FOR RENEWAL OF TRADEMARK/SERVICE MARK This application must be accompanied by a specimen showing actual use of the mark and the $50 filing fee for each classification claimed. 1 . APPLICANT NAME 2 . ADDRESS (NUMER & STREET) CITY STATE ZIP+4 3 . NAME AND DESCRIPTION OF MARK TO BE RENEWED PURSUANT TO ARTICLE 24 OF THE GENERAL BUSINESS LAW 4 . DATE THE MARK WAS REGISTERED WITH THE 5.ORIGINAL REGISTRATION NUMBER 6.SPECIFY TYPE T R A D E M A R K SECRETAR Y OF STATE OF THE STATE OF NEW YORK OF MARK BEING RENEWED SERVICE MARK T he above reference mark has been and still is in use. (Signature of Applicant) State of New York, County of } ss: I , , being duly sworn, depose and state that I am the person d escribed in the foregoing application and that I have read the foregoing application and know the contents thereo f to be true, except as to the matters therein stated to be alleged upon information and belief, and as to those matters, I believe them to be true. (Name of Signer ) (Title of Signer) Sworn to me this day of , 20 X ( Notary Public ) DOS - 0247 - f - l - a (R ev. 10/18) Page 1 of 1 DOS use only Registration No.: American LegalNet, Inc. www.FormsWorkFlow.com