Expedite this Form: Prescribed by: The Ohio Secretary of State Central Ohio: (614) 466-3910 Toll Free: 1-877-SOS-FILE (1-877-767-3453) (Select One) Mail Form to one of the Following: Yes PO Box 1390 Columbus, OH 43216 *** Requires an additional fee of $100 *** www.sos.state.oh.us e-mail: busserv@sos.state.oh.us No PO Box 788 Columbus, OH 43216 NAME REGISTRATION UPDATE (For Domestic or Foreign, Profit or Nonprofit) Filing Fee $25.00 THE UNDERSIGNED DESIRING TO FILE A: This filing does not extend the registration period (CHECK ONLY ONE (1) BOX) (2) Name Reservation Transfer (1) Assignment of Registered Name Registration No. Registration No. (116-RNA) Change of Address only for Registered Name Registration No. (4) (176-RNB) (3) (185-NRT) (184-RNX) Cancellation of Registration Registration No. Check The Appropriate Box Fictitious Name Trade Name Mark of Ownership Trademark Service Mark Name of Entity or Description of Mark Name of Current Owner Complete the information in this section if box (3) is checked. New Business Address (Street) NOTE: P.O. Box Addresses are NOT acceptable. (City) (County) (State) (Zip Code) Complete the information in this section if box (1) or (2) is checked. Are you assigning this name? New Registrant's Name & Address Yes No (Name) (Street) NOTE: P.O. Box Addresses are NOT acceptable. (City) (County) (State) (Zip Code) Registration No. Complete the information in this section if box (4) is checked. Are you canceling this name? 524 Yes No Page 1 of 2 Last Revised: May 2002 American LegalNet, Inc. www.FormsWorkflow.com Complete the information in this section if box (1) is checked. Please indicate the assignment of the good will of the business as follows: For the amount of and for other Good and Valuable Consideration, the receipt of which is hereby acknowledged, ASSIGNOR does hereby assign unto said ASSIGNEE the entire right, title and interest in and to the above-listed mark and registration granted therefrom, and in and to the goodwill of the business in connection with which said mark is used, the same to be held and enjoyed by said ASSIGNEE for its own use and benefit, and for the use and benefit of its successors, assigns or other legal representatives, as fully and entirely as the same would have been held and enjoyed by said ASSIGNOR, if this assignment had not been made. If the goodwill of the business associated with this mark is NOT ASSIGNED REQUIRED Must be authenticated (signed) by an authorized representative (See Instructions) 524 Authorized Representative Page 2 of 2 Date Last Revised: May 2002 American LegalNet, Inc. www.FormsWorkflow.com Instructions for Name Registration Update Follow these instructions in this section if an item in box (1) is checked. Any trade name or fictitious name and its registration or report shall be assignable by an instrument in writing duly executed and may be recorded with the secretary of state upon the payment of a fee, payable to the secretary of state who, recording the assignment, shall issue in the name of the assignee a new certificate for the remainder of the term of the registration or report or the last renewal thereof. The instrument shall be on a form prescribed by the secretary of state. Follow these instructions in this section if an item in box (2) is checked. The name reservaton may be transferred by the applicant or other holder thereof by the filing in the office of the secretary of state of a written transfer, on a form prescribed by the secretary of state, stating the name and address of the transferee. Follow these instructions in this section if an item in box (3) is checked. The registrant of any trade name or a person who reports a fictitious name shall record all changes of the registrant's business address by filing with the secretary of state a statement in writing, on a form prescribed by the secretary of state, setting forth the name previously registered or reported, the date of the registration or report, and the new address of the applicant. Follow these instructions in this section if an item in box (4) is checked. I. The secretary of state shall cancel from the secretary of state's files: A. Any registration concerning which the secretary of state receives a voluntary request in writing, on a form prescribed by the secretary of state, for cancellation of the registration from the registrant or the assignee of record. B. All registrations granted under Title 13 of the ORC that are not renewed in accordance with Title 13 of the ORC. C. Any registration that the secretary of state finds was granted improperly. D. Any registration ordered cancelled by a court of competent jurisdiction on any ground. Follow these instructions in this section for Authorized Representative Must be signed by current owner. American LegalNet, Inc. www.FormsWorkflow.com