Page 1 of 6Form 555Last Revised: 06/2019 Toll Free: 877.767.3453 | Central Ohio: 614.466.3910 OhioSoS.gov | business@OhioSoS.gov File online or for more information: OhioBusinessCentral.gov Filing Form Cover LetterPlease return the approval certificate to: Address: City: ZIP Code: Phone Number: E-mail Address: Check here if you would like to receive important notices via e-mail from the Ohio Secretary of State's office regarding Business Services. Check here if you would like to be signed up for our Filing Notification System for the business entity being created or updated by filing this form. This is a free service provided to notify you via e-mail when any document is filed on your business record. Please make checks or money orders payable to: "Ohio Secretary of State" Type of Service Being Requested: (PLEASE CHECK ONE BOX BELOW) Regular Service: Only the filing fee listed on page one of the form is required and the filing will be processed in approximately 3-7 business days. The processing time may vary based on the volume of filings received by our office. Expedite Service 1: By including an Expedite fee of $100.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 2 business days after it is received by our office. Expedite Service 2: By including an Expedite fee of $200.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 1 business day after it is received by our office. This service is only available to walk-in customers who hand deliver the document to the Client Service Center. Expedite Service 3: By including an Expedite fee of $300.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 4 hours after it is received by our office, if received by 1:00 p.m. This service is only available to walk-in customers who hand deliver the document to the Client Service Center. Preclearance Filing: A filing form, to be submitted at a later date for processing, may be submitted to be examined for the purpose of advising as to the acceptability of the proposed filing for a fee of $50.00. The Preclearance will be complete within 1-2 business days. Name (Individual or Business Name): To the Attention of (if necessary): State American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 6Form 555Last Revised: 06/2019Toll Free: 877.767.3453 Central Ohio: 614.466.3910 OhioSoS.gov business@OhioSoS.gov File online or for more information: OhioBusinessCentral.gov Mail this form to one of the following: Regular Filing (non expedite) P.O. Box 1329 Columbus, OH 43216 Expedite Filing (Two business day processing time. Requires an additional $100.00) P.O. Box 1390 Columbus, OH 43216 Form 555 Prescribed by: Trademark and Service Mark Application Filing Fee $125.00 (174-TSMO) Form Must Be Typed Name of ApplicantIf the applicant is a partnership or limited partnership, please provide the names of all general partners:If the applicant is a corporation, partnership, limited partnership or limited liability company, please provide the jurisdiction of formation. Jurisdiction of Formation Name(s) ZIP Code City Mailing AddressBusiness address of applicant. State For screen readers, follow instructions located at this path. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 6Form 555Last Revised: 06/2019 Describe the mark. The description you provide is the way the mark will be recorded on our database. Describe the goods or services used in connection with the mark. Describe mode or manner in which the mark is used on or in connection with the goods or services.The mark has been used in business by the applicant (or predecessor) since Date (MM/DD/YYYY)and used in Ohio since .The applicant is the owner of the mark, the mark is in use, and to the knowledge of the person verifying the application, no other person has the right to use the mark in Ohio either in the identical form of the mark, or in near resemblance to the mark, as to be likely, when used on or in connection with the goods or services of another person, to cause confusion or mistake or to deceive. To the knowledge of the person verifying the application, no other person has a registration or a pending intent to use application of the same or a confusingly similar mark in the United States Patent and Trademark office for the same or similar goods or services. OR of a concurrent registration in the United States Patent and Trademark office of the applicant's mark covering an area including Ohio. Date (MM/DD/YYYY) A specimen of the mark which shows the mark in use is attached to the application. The class in which the goods or services fall (see list following form.) Applicant is the owner Applicant is NOT the owner American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 6Form 555Last Revised: 06/2019 Print Name By (if applicable) Signature Print Name By (if applicable) SignatureBy signing and submitting this form to the Ohio Secretary of State, the undersigned hereby certifies that he or she has the requisite authority to execute this document.Required Must be signed by the applicant or an authorized representative of the applicant. If authorized representative is an individual, then they must sign in the "signature" box and print their name in the "Print Name" box. If authorized representative is a business entity, not an individual, then please print the business name in the "signature" box, an authorized representative of the business entity must sign in the "By" box and print their name in the "Print Name" box. American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 6Form 555Last Revised: 06/2019Instructions for Trademark and Service Mark Application This form should be used by any person who adopts and uses a trademark or service mark in Ohio. Applicant Information Please provide the name of the applicant. If the applicant is a corporation, partnership, limited partnership, or limited liability company, please provide the jurisdiction of formation which would either be Ohio or another state or jurisdiction. Also, if the applicant is a partnership or limited partnership, please provide the names of all general partners. Please provide the business address of the applicant. This address can be in Ohio or outside of Ohio. Description of the Mark Please provide a written description of the mark - the language used on the application will be entered exactly as written into the database in the secretary of state's office. Also, please describe the goods or services on or in connection with which the mark is used. For example, if the applicant is a clothing manufacturer then the goods used in connection with the mark will be 223clothes.224 Then provide the class in which the goods or services fall. To locate the appropriate class, please look at the list provided on pages 4, 5 and 6 of the form. In the example provided above, the appropriate class would be 25 for 223Clothing, footwear, headgear.224 Finally, please provide the mode or manner in which the mark is used on or in connection with the goods or services. For example, the mark might be used in advertisements and letterhead in connection with the applicant's clothing business. Date of First Use Please provide the date when the mark was first used by the applicant (or predecessor) in any location and the date when it was first used in Ohio by the applicant (or predecessor). Note: the mark must be in use prior to filing the application; therefore, this date must be on the date of filing or prior to the date of filing. Statements regarding Use of the Mark By submitting this form, the applicant agrees to the statements provided on page 2 of the form and also selects the appropriate box to indicate whether the applicant is or is not the owner of a concurrent registration in the United States Patent and Trademark Office. Specimen The form must be accompanied by a specimen of the mark as actually used. In the example above, an appropriate specimen would be a copy of the letterhead showing the mark in use which advertises the clothing company. Our office will accept originals, photocopies and a copy of a photog