TRADEMARK / SERVICE MARK REGISTRATION SECRETARY OF STATE SFN 13400 (09-2015) For Office Use Only ID Number: WO Number: 1. FILING FEE $30.00 - One class of goods or services $20.00 - Each additional class of goods or services TEN YEAR REGISTRATION 3. Owner 2. Two exact facsimiles of the trademark or service mark must be attached. Colored facsimiles are required if color is a distinguishing characteristic. Filed: Expiration Date: By: SEE INSTRUCTIONS FOR FILING AND MAILING GUIDANCE For reference, see North Dakota Century Code, Chapter 47-22. 4. Social Security/Federal ID Number 5. Telephone Number 7. Toll-Free Telephone Number 6. Address of owner's principal place of business (Street/RR, PO Box, City, State ZIP+4) 8. The owner is a(n): (check one) Individual/Sole Proprietor General Partnership (see #9) Corporation - State of origin: Limited Liability Company - State of origin: Limited Partnership, Limited Liability Partnership, or Limited Liability Limited Partnership - State of origin: Other - Define (see instructions): 9. General Partnerships Only: List the names, social security or federal ID numbers, and addresses of the principal places of business for all partners COMPLETE ADDRESS Federal ID/Social Name Post Office Box City State ZIP+4 Security Number Street/Rural Route 10. Provide a specific and detailed description of the trademark or service mark as you want to have it protected, including features such as colors, words, lettering, pictures, designs, etc. (the words "see attached facsimile" cannot be accepted) 11. Mark is used to promote, or in connection with, the following goods or services 12. Classification of goods or services as designated in statutory list (provide the actual categories, not just the class number) 13. Describe how mark is used, or manner in which it is associated with a product or service (i.e. on a label, imprinted on the product, used in advertising, or building or vehicle signs, etc.) 14. Date mark first used by applicant or predecessor in business anywhere (MM/DD/YYYY) 15. Date mark first used by applicant or predecessor in business in North Dakota (MM/DD/YYYY) 16. "I (We) own the mark and no other person has the right to use such mark in North Dakota either in the identical form thereof or in such near resemblance thereto as might be calculated to deceive or to be mistaken therefor. I (We), the owner(s), state that I (we) have read the foregoing registration, know the contents thereof, and believe the statements made thereon to be true." Signature Signature 17. Name of person to contact about this document Email Address American LegalNet, Inc. www.FormsWorkFlow.com Date Date Daytime Telephone Number SFN 13400 (09-2015) Page 2 of 4 INSTRUCTIONS FOR TRADEMARK OR SERVICE MARK REGISTRATION Any person or entity that has adopted a mark to distinguish their goods or services from goods or services made or sold by another, may register that mark with the Secretary of State. The mark may be a word, name, symbol, or device, or any combination thereof. A word or slogan may be registered only when it clearly distinguishes products or services from those of another. The registration of a trademark or service mark with the Secretary of State provides protection of the mark in North Dakota. However, if a mark is registered with the Patent and Trademark Office in Washington, D.C., the federal registration may supersede the protection afforded by state law. In the event that a mark or name is used that is deemed to be the same as, or deceptively similar, to a trademark or service mark that is already registered, the registrant of such mark may institute a civil suit to enjoin the manufacture, use, display, or sale of any counterfeits or imitations. (See North Dakota Century Code, Section 47-22-12.) The trademark or service mark submitted for registration may not be the same as, or deceptively similar to, another mark or name registered with the Secretary of State. (See North Dakota Century Code, Section 47-22-02.) The Secretary of State may not file any trademark or service mark submitted for filing if the mark is determined to be the same as, or deceptively similar to, a previously filed name or mark. The following numbers correspond to the numbered sections on page 1 of this form: 1. The registration fee is $30 if a trademark or service mark is associated with only one class of goods or services. If associated with more than one class of goods or services, the fee is $20 for each additional class. (See number 12 to identify the applicable classes). Checks must be payable to "Secretary of State" and must be negotiable U.S. funds. Payment may also be made by credit card using Visa, Master Card, or Discover. Attach two identical facsimiles of the mark to the application. 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. Provide the full names of all the owners. If the owner is a corporation, a limited liability company, a limited partnership, a limited liability partnership, or a limited liability limited partnership registered with the Secretary of State, the owner's name must be identical to that as registered. To properly maintain trademark or service mark records, the social security or federal ID number(s) of the owner(s) 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. 6. The telephone number of the owner is required. Provide the complete mailing address of the owner'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. 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