Expedite this Form: (Select One) Prescribed by: The Ohio Secretary of State Central Ohio: (614) 466-3910 Toll Free: 1-877-SOS-FILE (1-877-767-3453) Mail Form to one of the Following: Yes PO Box 1390 Columbus, OH 43216 *** Requires an additional fee of $100 *** No PO Box 1329 Columbus, OH 43216 www.sos.state.oh.us e-mail: busserv@sos.state.oh.us TRADE MARK / SERVICE MARK APPLICATION STATE OF OHIO (For Domestic or Foreign, Profit or Nonprofit) Filing Fee $125.00 (174-TSMO) (CHECK ONLY ONE (1) BOX) To the SECRETARY OF STATE BE IT KNOWN, that the undersigned applicant is an: individual firm partnership corporation association union of working men or other organization, has adopted and used in this state the: (CHECK ONLY ONE (1) BOX) trade mark service mark for which application for registration is hereby made in compliance with the provisions of Revised Code Sections 1329.54 to 1329.67 by filing with the Secretary of State of Ohio the following information: 1. a. The name of the applicant is b. The business address of the applicant is (street address) NOTE: P.O. Box Addresses are NOT acceptable. (state) (city, township, or village) (zip code) 2. a. If applicant is a corporation, the state of incorporation is (state) b. If applicant is a partnership or limited liability partnership, the state in which the partnership is organized is and the names of the general partners. c. If the applicant is a limited liability company, the state of its organization: 3. The goods or services in connection with which the mark is used: 4. The manner in which the mark is used in connection with such goods or services: 555 Page 1 of 5 (See instructions) Last Revised Apr. 2004 American LegalNet, Inc. www.FormsWorkflow.com 5. The class in which such goods or services fall: (See instructions) 6. The date when the trade mark or service mark was first used anywhere: (Date) 7. The date when the mark was first used in Ohio by the applicant or his predecessor in business: (Date) 8. If mark used by predecessor in business, give name and address of predecessor: (name) (street address) NOTE: P.O. Box Addresses are NOT acceptable. , Ohio (zip code) (city, village or township) 9. The applicant is the owner of the trade mark/service mark and no other person has the right to use the mark in the State of Ohio either in the identical form or in such near resemblance as might be calculated to deceive or be mistaken for it. 10. No other person has a registration of the same or of a confusingly similar trade mark/service mark in the United States Patent Office for the same or similar goods. (See instructions.) 11. I am am not the owner of a concurrent registration in the United States Patent Office of this trade mark/ service mark covering an area including this State: (See instructions.) 12. The mark is described IN WORDS as follows: 13. A specimen or facsimile of the mark accompanies this application. State of Ohio County of ss. I, the applicant herein, being first duly sworn, depose and say that the facts set forth in this application are true, as I verily believe, and that the copies, counterparts or facsimiles filed herewith are true and correct. Signature: (Applicant, Authorized Rep., Officer) (Title, if applicant is not an individual) Subscribed and sworn to me on (date) Signature: Notary Seal (Notary Public) Expiration date of Notary's Commission (date) 555 Page 2 of 5 Last Revised Apr. 2004 American LegalNet, Inc. www.FormsWorkflow.com CLASSIFICATION OF GOODS FOR REGISTRATION OF TRADE MARKS (Question 5 on the Application Blank) The following classification of goods is established to be used in the registration of trade marks, and is established by the Secretary of State of Ohio in conformity with the classification established by the Commissioner of Patents as required by ORC Section 1329.63. A single application for registration of a trade mark may include any or all of the goods listed in a single class upon which the trade mark is actually being used, but no application shall be accepted which lists goods that fall within different classes. GOODS CLASS 1. Chemical used in industry, science and photography, as well as in unprocessed plastics; manures; fire extinguishing compositions; tempering and soldering preparations; chemical substances for preserving foodstuffs; tanning substances; adhesives used in industry. CLASS 2. Paints, varnishes, lacquers; preservatives against rust and against deterioration of wood; colorants; mordants; raw natural resins; metals in foil and power form for painters, decorators, printers and artists. CLASS 3. Bleaching preparations and other substances for laundry use; cleaning, polishing, scouring, and abrasive preparations; soaps; perfumery, essential oils, cosmetics, hair lotions; dentifrices. CLASS 4. Industrial oils and greases; lubricants; dust absorbing wetting and binding compositions; fuels (including motor spirit) and illuminants; candies, wicks. CLASS 5. Pharmaceutical, veterinary and sanitary preparations; dietetic substances adapted for medical use; food for babies; plasters, materials for dressings; material for stopping teeth, dental wax; disinfectants; preparations for destroying vermin; fungicides, herbicides. CLASS 6. Common metals and their alloys; metal building materials; transportable buildings of metal; materials for metal for railway tracks; non-electric cables and wires of common metal; ironmongery, small items of metal hardware; pipes and tubes of metal; safes; goods of common metal not included in other classes; ores. CLASS 7. Machines and machine tools; motors (except for land vehicles); machine coupling and belting (except for land vehicles); agricultural implements; incubators for eggs. CLASS 8. Hand tools and implements (hand operated); cutlery; side arms; razors. CLASS 9. Scientific, nautical, surveying, electric, photographic, cinematographic, optical, weighing, measuring, signaling, checking (supervision), life-saving and teaching apparatus and instruments: apparatus for recording, transmission or reproduction of sound or images; magnetic data carriers, recording discs: automatic vending machines and mechanisms for coin-operated apparatus; cash registers, calculating machines, data processing equipment and computers; fire-extinguishing apparatus. CLASS 10. Surgical, medical, dental and veterinary apparatus and instruments, artificial limbs, eyes and teeth; orthopedic articles; suture materials. CLASS 11. Apparatus for lighting, heating, steam generating, cooking refrigerating, dying, ventilating water supply and sanitary purposes. CLASS 12. Vehicles; apparatus for locomotion by land, air or water. CLASS 13. Firearms, ammunition and projectiles; explosives; fireworks. CLASS 14. Precious metals and their alloys and goods in precious metals or coating therewith, not included in other classes; jewelry, precious stones; homological and chronometric instruments. CLASS 15. Musical instruments. 555 Page 3 of 5 Last Revised Apr. 2004 American LegalNet, Inc. www.FormsWorkflow.com CLASS 16. Paper, cardboards, and goods made from these materials, not included in other classes; printed matter, bookbinding material; photographs; stationery; adhesives for stationery or household purposes, artists' materials; paint brushes. typewriters and office requisites (except furniture); instructional and teaching material (except apparatus): plastic materials for packaging (not included in other classes); playing cards; printers' type; printing blocks. CLASS 17. Rubber, gutta-percha, gum, asbestos, mica and goods made from these materials and not included in other classes; plastics in extruded form for use in manufacture; packing, stopping and insulating materials; flexible pipes, not of metal. CLASS 18. Leather and imitations of leather, and goods made of these materials and not included on other classes; animal skins, hides; trunks and traveling bags: umbrellas, parasols and walking sticks; whips, harness and saddlery. CLASS 19. Building materials (non-metallic); non metallic rigid pipes for buildings; asphalt, pitch and bitumen; nonmetallic transportable buildings; monuments, not of metal. CLASS 20. Furniture, mirrors, picture frames; goods (non included in other classes) of wood, cork, red, cane, wicker, horn, bone, ivory, whalebone, shell, amber, mother-of-pearl, meerschaum and substitutes for all these materials, or of plastics. CLASS 21. Household or kitchen utensils and containers (not of precious metal or coated therewith); combs and sponges; brushes (except paint brushes); brush-making materials; articles for cleaning purposes; steel wool; un-worked or semi-worked glass (except glass used in building); glassware, porcelain and earthenware not included in other classes. CLASS 22. Ropes, string, nets, tents, awnings, tarpaulins, sails, sacks and bags (not included in other classes); padding and stuffing materials (except of rubber or plastics); raw fibrous textile materials. CLASS 23. Yarns and threads, for textile use. CLASS 24. Textiles and textile goods, not included in other classes; bed and table covers. CLASS 25. Clothing, footwear, headgear. CLASS 26. Lace and embroidery, ribbons and braid; buttons, hooks and eyes, pins and needles; artificial flowers. CLASS 27. Carpets, rugs, mats and matting, linoleum and other materials for covering existing floors; wall hangings (non-textile). CLASS 28. Games and playthings; gymnastic and sporting articles not included in other classes; decorations for Christmas trees. CLASS 29. Meat, fish, poultry, and game; meat extracts; preserved, dried and cooked fruits and vegetables; jellies, jams; eggs, milk and milk products; edible oils and fats; salad dressings; preserves. CLASS 30. Coffee, tea, sugar, cocoa, rice, tapioca, sago, artificial coffee; flour and preparations made from cereals, bread, pastry and confectionery, ices: honey, treacle; yeast, baking powder; salt, mustard; vinegar, sauces (except salad dressings); spices; ice. CLASS 31. Agricultural, horticultural and forestry products and grains not included in other classes; living animals; fresh fruits and vegetables; seeds, natural plants and flowers; foodstuffs for animals, malt. CLASS 32. Beers; mineral and aerated waters and other non-alcoholic drinks; fruit drinks and fruit juices; syrups and other preparations for making beverages. CLASS 33. Alcoholic beverages (except beers). CLASS 34. Tobacco; smokers' articles; matches. 555 Page 4 of 5 Last Revised Apr. 2004 American LegalNet, Inc. www.FormsWorkflow.com CLASSIFICATION OF SERVICES FOR REGISTRATION OF SERVICE MARKS (Question 5 on the Application Blank) The following classification of services is established to be used in the registration of service marks, and is established by the Secretary of State of Ohio in conformity with the classification established by the Commissioner of Patents as required by ORC Section 1329.63 A single application for registration of a service mark may include any or all of the services listed in a single class with which the service mark is actually being used, but no application shall be accepted which lists services that fall within different classes. SERVICES CLASS 35. Advertising and business services which directly assist in the operation or management of another commercial enterprise. CLASS 36. Insurance and financial services, to include banking, credit unions, stock brokers and realty administrators. CLASS 37. Construction and repair of buildings and other physical structures, painting, plumbing, roofing, remodeling; repair of objects, including tools, furniture, appliances and electronics. CLASS 38. Communications, including broadcast/transmission of television, telephone, teletype, radio and other electronic transmission media. CLASS 39. Transportation to include air, land or sea transport; packaging storage and warehousing for transport; travel services related to transport only. CLASS 40. Material treatment, including processing or transformation of an object/substance, changing its essential properties. Does not include repair. CLASS 41. Education and entertainment. Includes schools, training for animals, services having the basic aim to amuse, entertain, recreation. CLASS 42. Scientific and technological services and research and design relating thereto; industrial analysis and research services; design and development of computer hardware and software; legal services. CLASS 43 Services for providing food and drink; temporary accommodations CLASS 44 Medical services; veterinary services; hygienic and beauty care for human beings or animals; agriculture, horticulture and forestry services CLASS 45 Personal and social services rendered by others to meet the needs of individuals; security for the protection of property and individuals 555 Page 5 of 5 Last Revised Apr. 2004 American LegalNet, Inc. www.FormsWorkflow.com Instructions for Trade Mark/Service Mark Application Use Tab key to move between entry fields 1. Be sure to read the introductory paragraph and check the appropriate terms. 2. Line 4. The manner of use is how the mark will be displayed, such as on signs, letterhead stationery, packaging, etc. 3. Line 5. Select the appropriate class from the list below. Classes 1 through 34 are for trade marks;. classes 35 through 42 for service marks. Only ONE class per application is permitted. Detailed class descriptions are on attached sheet. 4. Lines 10 and 11. The applicant must verify the statement on Line 10 or be the owner of a current registration of this mark with the United States Patent Office. The applicant may obtain information on how to apply for a federal registration by contacting the USPO at 703-308-9000. The USPO does not conduct pre-application searches. 5. A specimen or facsimile of the mark must accompany this application. 6. Signature. The application must be verified and signed by the applicant or an authorized representative, or an officer of the firm, limited liability company, limited liability partnership, general partnership, limited partnership, corporation, union, association, or other organization that is the applicant. THIS REGISTRATION is effective for a term of 10 years from the date thereof. The applicant may renew the registration within six months prior to the expiration of such term. CLASSIFICATION OF GOODS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Chemicals Paints Cosmetics and cleaning preparations Lubricants and fuels Pharmaceuticals Metal goods Machinery Hand tools Electrical and scientific apparatus Medical apparatus Environmental control apparatus Vehicles Firearms Jewelry Musical Instruments Paper goods and printed matter Rubber goods CLASSIFICATION OF SERVICES 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 Leather Goods Non-metallic building materials Furniture Housewares and glass Cordage and fibers Yarns and threads Fabrics Clothing Fancy goods Floor coverings Toys and sporting goods Meats and processed foods Staple foods Natural agricultural products Light beverages Wines and spirits Smokers' articles 35 36 37 38 39 40 41 42 43 44 Advertising and business insurance and financial Construction and repair Communication Transportation and storage Material treatment Education and entertainment Scientific and technological Providing food and drink Medical, veterinary, hygienic, agriculture and forestry 45 Personal, Social and security American LegalNet, Inc. www.FormsWorkflow.com