FOR OFFICE USE ONLY TRADEMARK/SERVICE MARK ASSIGNMENT ID#: SECRETARY OF STATE SFN 13408 (03-06) WO#: Filed: 1. FILING FEE: $30.00 By: 2. Two exact facsimiles of the trademark or service mark must be attached. Colored facsimiles are required if color is a distinguishing characteristic. SEE INSTRUCTIONS FOR FILING AND MAILING GUIDANCE 3. Assignor: (owner currently recorded with the Secretary of State) Expiration Date: For reference, see North Dakota Century Code, Chapter 47-22. 4. Social Security/Federal ID #: 5. Telephone #: 6. Address of assignor's principal place of business: (Street/RR, PO Box, City, State, Zip+4) 7. Toll-Free Telephone #: 8. Assignee: (Person or entity to whom ownership of mark is transferred) 10. Telephone #: 9. Social Security/Federal ID #: 11. Address of assignee's principal place of business: (Street/RR, PO Box, City, State, Zip+4) 12. Toll-Free Telephone #: 13. The assignee is: (select one) Corporation incorporated in State of _________________________________ Individual/Sole Proprietor Limited Liability Company organized in State of ________________________ General Partnership (see #13) Limited Partnership, Limited Liability Partnership, or Limited Liability Limited Other. Define (see instructions) ____________________________ Partnership organized in State of ___________________________________ 14. If assignee is a general partnership, list all partners, their Social Security/Federal ID #'s, and the addresses of their principal places of business: SOCIAL SECURITY/ FEDERAL ID # NAME COMPLETE ADDRESS Street/RR PO Box City State Zip+4 15. Provide a specific and detailed description of the trademark or service mark as you wish to have it protected including features such as color, words, lettering, pictures or designs, etc.: (The words "see attached facsimile" cannot be accepted.) 16. The mark is used to promote, or in connection with, the following goods or services: 17. Classification of goods or services as designated in statutory list: (Provide the actual categories, not just the class number.) (See instructions, page 3) 18. Describe how the mark is used, or manner in which it is associated with a product or a service, (e.g. on a label, imprinted on the product, used in adverstising, on building or vehicle signs, etc.) 19. Date on which this mark was first used by the applicant or predecessor in business anywhere: (month, day, and year) 20. Date on which this mark was first used by the applicant or predecessor in business in North Dakota: (month, day, and year) 21. "The assignor(s) declare(s) he/she is/are the owner(s) of this mark and hereby assign(s) this mark to the assignee with the good will of the business connected with the use of, and symbolized by, the mark. I (We), the assignor(s), say that I (we) have read the foregoing assignment, know the contents thereof, and believe the statements made thereon to be true." Original Signature of assignor Date 22. Name of person to contact if questions about this registration: Original Signature of assignor E-mail address: Date Daytime telephone #: American LegalNet, Inc. www.FormsWorkflow.com SFN 13408 (03-06) Page 2 INSTRUCTIONS FOR TRADEMARK/SERVICE MARK ASSIGNMENT To transfer ownership of a trademark or service mark registered with the Secretary of State, the registrant of record must file a Trademark/Service Mark Assignment. Upon filing the Trademark/Service Mark Assignment, the Secretary of State issues, in the name of the assignee, a new certificate for the remainder of the term of the ten-year registration, or the last renewal thereof. An assignment filed with the Secretary of State does not extend the registration period. The expiration date is stated on the new certificate. The following numbers correspond to the numbered sections on the front of this form. 1. The assignment fee is $30. Checks must be payable to the "Secretary of State" and must be nogotiable U.S. funds. Payment may also be made by credit card using VISA, MasterCard, or Discover. 2. Attach two identical facsimiles of the mark to the assigment. The facsimiles may be in the form of an actual label or tag, or a photograph. If color of the mark is a distinguishing characteristic, colored facsimiles must be provided. 3. Provide the full name of the assignor who is the owner of the trademark or service mark as currently recorded with the Secretary of State. If the owner is a corporation, a limited liability company, a limited partnership, a limited liability partnership, or a limited liability limited partnership filed with the Secretary of State, the assignor's name must be identical to that as registered. 4. To properly maintain trademark or service mark records the Social Security or Federal ID number(s) of the assigner is requested. In compliance with the Federal Privacy Act of 1974, the disclosure of the Social Security or Federal ID number on this form is voluntary. The number is not disclosed to the public. It is used by the Secretary of State to maintain accurate trademark and service mark files. Therefore, while voluntary disclosure is requested, failure to do so will not result in rejection of the registration. 5. The telephone number of the assignor is required. 6. Provide the complete mailing address of the assignor's principal place of business. In this section, an address must include either a street or rural address and/or a post office box number if required for mailing purposes, in addition to the city, state, and zip code. 7. Provide the toll-free telephone number if the assignor has one. 8. Provide the full name of the assignee who is the person or entity to whom ownership of the mark is transferred. If the assignee is a corporation, a limited liability company, a limited partnership, a limited liability partnership, or a limited liability limited partnership filed with the Secretary of State, the assignee's name must be identical to that as registered. 9. To properly maintain trademark or service mark records the Social Security or Federal ID number(s) of the assignee is requested. (See number 3 regarding privacy of Social Security or Federal ID numbers.) 10. The telephone number of the assignor is required. 11. Provide the complete mailing address of the assignee's principal place of business. If the owner is a corporation, limited liability company, limited partnership, limited liability partnership, or limited liability limited partnership registered with the Secretary of State, the principal place of business address must correspond to that declared in the separate entity registration with the Secretary of State. When notice is received in the form of an annual report of an owner indicating that the address of the principal place of business is changed in the entity registration, such notice automatically effects a change in the trademark or service mark registration. 12. Provide the toll-free telephone number if the assignee has one. 13. Select the organizational structure which best defines the assignee. If the assignee is a corporation, a limited liability company, a limited partnership, a limited liability partnership, or a limited liability limited partnership include the state of origin. Any such entity created according to North Dakota laws must be in existence and on file with the Secretary of State before an assignment will be accepted for registration. A North Dakota general partnership using a fictitious name must have a Partnership Fictitious Name Certitficate on file with the Secreary of State before an assignment will be accepted for registration. If the assignee of the mark is an organizational structure defined as "other" and not mentioned above, the acceptance of an assignment will be assessed on a case-by-case basis. 14. If the assignee is a general partnership, provide the names of all partners, their social security or Federal ID numbers, and the complete addresses of their principal places of business. (See number 5 for definition of complete address.) (See number 3 regarding privacy of social security or Federal ID number.) 15. Provide a specific and detailed description of the mark. Describe the features of the mark including color, words, lettering, pictures, design, size, or any other characteristics of the mark. Attaching a facsimile and stating "see attached" cannot be accepted. The description of the mark may need to be more explicit than the previous registration. 16. Identify the services, goods, or products that will be associated with the mark. American LegalNet, Inc. www.FormsWorkflow.com SFN 13408 (03-06) Page 3 17. The goods and services associated with a mark are classified by North Dakota Century Code, Section 47-22-09. From the following schedule, identify all the classes of goods or services associated with the mark. (Since North Dakota's laws related to trademarks and service marks changed on March 13, 2003, the classification(s) may be different for the assignee than those previously recorded for the assignor.) GOODS: 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) 23) 24) 25) 26) Raw or partly prepared materials. Receptacles. Baggage, animal equipment, portfolios and pocketbooks. Abrasives and polishing materials. Adhesives. Chemicals and chemical compositions. Cordage. Smokers' articles, not including tobacco products. Explosives, firearms, equipments, and projectiles. Fertilizers. Inks and inking materials. Construction materials. Hardware and plumbing and steam-fitting supplies. Metals and metal castings and forgings. Oils and greases. Paints and painters' materials. Tobacco products. Medicines and pharmaceutical preparations. Vehicles. Linoleum and oiled cloth. Electrical apparatus, machines, and supplies. Games, toys, and sporting goods. Cutlery, machinery, and tools, and parts thereof. Laundry appliances and machines. Locks and safes. Measuring and scientific appliances. 27) 28) 29) 30) 31) 32) 33) 34) 35) 36) 37) 38) 39) 40) 41) 42) 43) 44) 45) 46) 47) 48) 49) 50) 51) 52) Horological instruments. Jewelry and precious-metal ware. Brooms, brushes, and dusters. Crockery, earthenware, and porcelain. Filters and refrigerators. Furniture and upholstery. Glassware. Heating, lighting, and ventilating apparatus. Belting, hose, machinery packing and nonmetallic tires. Musical instruments and supplies. Paper and stationery. Prints and publications. Clothing. Fancy goods, furnishings, and notions. Canes, parasols, and umbrellas. Knitted, netted, and textile fabrics, and substitutes therefor. Thread and yarn. Dental, medical, and surgical appliances. Soft drinks and carbonated waters. Foods and ingredients of foods. Wines. Malt beverages and liquors. Distilled alcoholic liquors. Merchandise not otherwise classified. Cosmetics and toilet preparations. Detergents and soaps. 5) 6) 7) 8) Communications. Transportation and storage. Materials treatment. Education and entertainment. SERVICES: 1) 2) 3) 4) Miscellaneous services. Advertising and business. Insurance and financial. Construction and repair. 18. Describe how the mark is used or associated, (e.g., a tag or label attached to the product, appears on the wrapping of the product, appears on the box in which the product is contained, is in some manner imprinted on the product, is used in advertising, etc.) 19. Provide the date (month, day, and year) on which the mark was first used anywhere. 20. Provide the date (month, day, and year) on which the mark was first used in North Dakota. 21. The application must bear the original signature of the assignor and the date on which it was signed. 22. Provide the name, email address, and daytime telephone number of the person to contact for any issues related to the assignment. ASSISTANCE: If assistance is required to complete this assignment contact the Secretary of State's Business Division. EXPEDITING PROCESS: If the assignment is being submitted by someone other than the assignor or assignee, provide a cover letter with the name and telephone number of the responsible individual so that any deficiencies on the form can be remedied by telephone. AMENDMENT: Any registrant that effects a name change must record that name change with the Secretary of State. The Secretary of State must record the name change upon the payment of $30 and filing of the following: 1. A notarized statement reciting the name change if the registrant is an individual. 2. A certificate of fact reciting the name change duly authenticated by the proper officer of the state or country if the registrant is a corporation, limited liability company, limited partnership, limited liability partnership, or limited liability limited partnership incorporated or organized in another state or country and does not have a certificate of authority or registration to transact business in North Dakota. 3. An amendment or application for amended certificate of authority or registration for a registrant that is a corporation, limited liability company, limited partnership, limited liability partnership, or limited liability limited partnership registered with the Secretary of State. A registrant must notify the Secretary of State when effecting a change of address. An annual report of a corporation, limited liability company, limited partnership, limited liability partnership, or limited liability limited partnership filed with the Secretary of State that reflects a change of address of the principal place of business of a registrant serves as such notice. American LegalNet, Inc. www.FormsWorkflow.com SFN 13408 (03-06) Page 4 MAILING INSTRUCTIONS: Send an original assignment and appropriate fee to: Secretary of State State of North Dakota 600 E Boulevard Ave Dept 108 Bismarck ND 58505-0500 Telephone: 701-328-2904 Toll Free: 800-352-0867 (82904) Fax: 701-328-2992 Home Page: www.nd.gov/sos ASSIGNMENT: Any registrant that transfers ownership of a mark to another party must file Trademark/Service Mark Assignment. Contact the Secretary of State's Business Division for the form. Upon filing the Trademark/Service Mark Assignment, the Secretary of State issues, in the name of the assignee, a new certificate for the remainder of the ten-year term of the registration, or the last renewal thereof. An assignment does not extend the registration period. RENEWAL: The trademark or service mark registration lapses after a period of ten years from the date of registration. Ninety days prior to the lapse of the registration, the Secretary of State forwards a Trademark/Service Mark Renewal to the owner at the last recorded address. To insure delivery of a renewal notice, it is imperative that the owner's principal place of business address be maintained current with the Secretary of State. CANCELLATION: The Secretary of State shall cancel the trademark or service mark if anyone fails to file the renewal prior to the expiration date. The trademark or service mark is also cancelled when the registrant is a corporation, limited liablity company, limited partnership, limited liability partnership, or limited liability limited partnership that has failed to file an assignment and has ceased to exist for a period of six months. CREDIT CARD PAYMENT AUTHORIZATION SECRETARY OF STATE SFN 51478 (06-03) (All items required to complete transaction) Name: Address: VISA Account Number: State: City: Master Card Zip Code: Signature: (Required by credit card companies) Discover V# Card Expires: Month Year - Date: American LegalNet, Inc. www.FormsWorkflow.com