PENNSYLVANIA DEPARTMENT OF STATE CORPORATION BUREAU Application for Registration of Mark (54 Pa.C.S. § 1112) Document will be returned to the name and address you enter to the left. Name ⇐ Address City State Zip Code Fee: $50 In compliance with the requirements of the 54 Pa.C.S. § 1112 (relating to application for registration), the undersigned, having adopted and used a trade mark or service mark in this Commonwealth and desiring to register such mark, hereby states that: 1. The name of the applicant is (see instruction A): 2. The residence, location or place of business of the applicant is: Number and street City State Zip County 3. The name and description of the mark is (a facsimile of the mark to be registered accompanies this application as Exhibit A and is incorporated herein by reference): 4. General class in which such goods or services fall is (use only one of the classifications as set forth in the general classes of goods and services established by the United States Patent and Trademark Office attached): American LegalNet, Inc. www.FormsWorkflow.com DSCB:54-1112– 2 5. The goods or services in connection with which the mark is used and the mode and manner in which the mark is used in connection with such goods or services are: 6. The date when the mark was first used anywhere is: 7. The date when the mark was first used in this Commonwealth by the applicant or the predecessor in interest is: 8. The date, if any, an application to register the mark, or portions or a composite thereof, was filed by the applicant or a predecessor in interest in the United States Patent and Trademark Office. Also provide filing date and serial number of each application, the status thereof and, if any application was finally refused registration, or has otherwise not resulted in a registration, the reasons therefore. (Please attach 8½ x 11 sheet(s) if more space is needed.) 9. Applicant is the owner of the mark, that the mark is in use and that, to the applicant’s knowledge, no other person has registered, either federally or in this Commonwealth or has the right to use such mark, either in the identical form thereof or in such near resemblance thereto as to be likely, when applied to the goods or services of such other person, to cause confusion, or to cause mistake, or to deceive. IN TESTIMONY WHEREOF, the undersigned person has caused this Application for Registration of Mark day of , . to be executed this _________________________________________ Name of Applicant _________________________________________ Signature _________________________________________ Title American LegalNet, Inc. www.FormsWorkflow.com DSCB:54-1112-3 Department of State Corporation Bureau P.O. Box 8722 Harrisburg, PA 17105-8722 (717) 787-1057 web site: www.dos.state.pa.us/corps Instructions for Completion of Form: A. If a corporation, set forth the name in Paragraph 1 and also give jurisdiction of incorporation. If a partnership, set forth the name in Paragraph 1 and also give the jurisdiction in which the partnership is organized and the names of the general partners. B. Typewritten is preferred. If not, the form must be completed in black ink in order to permit reproduction. The filing fee for this form is $50 made payable to the Department of State. C. The name of a commercial registered office provider may not be used in Paragraph 2 in lieu of an address. D. An application for registration of a mark is limited to a single general class of goods or services, but a mark may be made the subject of multiple registrations in two or more general classes. (See general classes of goods and services established by the United States Patent and Trademark Office in accordance with the International Classification System attached). E. This registration is effective for a term of five years from the date of registration. Application to renew for a similar term must be made on form DSCB:54-1114 (Application for Renewal of Registration of Mark) within six months prior to the expiration of such term. F. This form and all accompanying documents shall be mailed to the address listed above. Schedule of classes of goods and services. American LegalNet, Inc. www.FormsWorkflow.com GOODS 1. Chemical products used in industry, science, photography, agriculture, horticulture, forestry; artificial and synthetic resins; plastics in the form of powders, liquids or pastes, for industrial use; manures (natural and artificial); fire extinguishing compositions; tempering substances and chemical preparations for soldering; chemical substances for preserving foodstuffs; tanning substances; adhesive substances used in industry. 2. Paints, varnishes, lacquers; preservatives against rust and against deterioration of wood; coloring matters, dyestuffs; mordants; natural resins metals in foil and powder form for painters and decorators. 3. Bleaching preparations and other substances for laundry use; cleaning, polishing, scouring and abrasive preparations; soaps; perfumery, essential oils, cosmetics, hair lotions; dentifrices. 4. Industrial oils and greases (other than edible oils and fats and essential oils); lubricants; dust laying and absorbing compositions; fuels (including motor spirit) and illuminants; candles, tapers, night-lights and wicks. 5. Pharmaceutical, veterinary and sanitary substances; infants' and invalids' foods; plasters, material for bandaging; material for stopping teeth, dental wax; disinfectants; preparations for killing weeds and destroying vermin. 6. Unwrought and partly wrought common metals and their alloys; anchors, anvils, bells, rolled and cast building materials; rails and other metallic materials for railway tracks; chains (except driving chains for vehicles); cables and wires (nonelectric); locksmiths' work; metallic pipes and tubes; safes and cash boxes; steel balls; horseshoes; nails and screws; other goods in nonprecious metal not included in other classes; ores. 7. Machines and machine tools; motors (except for land vehicles); machine couplings and belting (except for land vehicles); large size agricultural implements; incubators. 8. Hand tools and instruments; cutlery, forks and spoons; side arms. 9. Scientific, nautical, surveying and electrical apparatus and instruments (including wireless), photographic, cinematographic, optical, weighing, measuring, signaling, checking (supervision), lifesaving and teaching apparatus and instruments; coin or counter-fed apparatus; talking machines; cash registers; calculating machines; fire extinguishing apparatus. 10. Surgical, medical, dental and veterinary instruments and apparatus (including artificial limbs, eyes and teeth). 11. Installations for lighting, heating, steam generating, cooking, refrigerating, drying, ventilating, water supply and sanitary purposes. 12. Vehicles; apparatus for locomotion by land, air or water. 13. Firearms; ammunition and projectiles; explosive substances; fireworks. 14. Precious metals and their alloys and goods in precious metals or coated therewith (except cutlery, forks and spoons); jewelry, precious stones, horological and other chronometric instruments. 15. Musical instruments (other than talking machines and wireless apparatus). 16. Paper and paper articles, cardboard and cardboard articles; printed matter, newspapers and periodicals, books; bookbinding material; photographs, stationery, adhesive materials (stationery); artists' materials; paint brushes; typewriters and office requisites (other than furniture); instructional and teaching material (other than apparatus); playing cards; printers' type and cliches (stereotype). 17. Gutta-percha, India rubber, balata and substitutes, articles made from these substances and not included in other classes; plastics in the form of sheets, blocks and rods, being for use in manufacture; materials for packing, stopping or insulating; asbestos, mica and their products; hose pipes (nonmetallic). 18. Leather and imitations of leather, and articles made from these materials and not included in other classes; skins, hides; trunks and traveling bags; umbrellas, parasols and walking sticks, whips, harness and saddlery. 19. Building materials, natural and artificial stone, cement, lime, mortar, plaster and gravel; pipes of earthenware or cement; road-making materials; asphalt, pitch and bitumen; portable buildings; stone monuments; chimney pots. 20. Furniture, mirrors, picture frames; articles (not included in other classes) of wood, cork, reeds, cane, wicker, horn, bone, ivory, whalebone, shell, amber, mother-of-pearl, meerschaum, celluloid, substitutes for all these materials, or of plastics. 21. Small domestic utensils and containers (not of precious metal or coated therewith); combs and sponges; brushes (other than paint brushes); brush-making materials; instruments and material for cleaning purposes; steel wool; glassware, porcelain and earthenware, not included in other classes. 22. Ropes, string, nets, tents, awnings, tarpaulins, sails, sacks; padding and stuffing materials (hair, capoc, feathers, seaweed, etc.); raw fibrous textile materials. 23. Yarns, threads. 24. Tissues (piece goods); bed and table covers; textile articles not included in other classes. 25. Clothing, including boots, shoes and slippers. 26. Lace and embroidery, ribbons and braid; buttons, press buttons, hooks and eyes, pins and needles; artificial flowers. 27. Carpets, rugs, mats and matting; linoleums and other materials for covering floors; wall hangings (nontextile). 28. Games and playthings; gymnastic and sporting articles (except clothing); ornaments and decorations for Christmas trees. 29. Meat, fish, poultry and game; meat extracts; preserved, dried and cooked fruits and vegetables; jellies, jams; eggs, milk and other dairy products; edible oils and fats; preserves, pickles. 30. Coffee, tea, cocoa, sugar, rice, tapioca, sago, coffee substitutes; flour and preparations made from cereals; bread, biscuits, American LegalNet, Inc. www.FormsWorkflow.com 31. 32. 33. 34. cakes, pastry and confectionery, ices, honey, treacle; yeast, baking powder; salt, mustard; pepper, vinegar, sauces, spices; ice. Agricultural, horticultural and forestry products and grains not included in other classes; living animals; fresh fruits and vegetables; seeds; live plants and flowers; foodstuffs for animals, malt. Beer, ale and porter; mineral and aerated waters and other nonalcoholic drinks; syrups and other preparations for making beverages. Wines, spirits and liqueurs. Tobacco, raw or manufactured; smokers' articles; matches. SERVICES 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. Advertising and business. Insurance and financial. Construction and repair. Communication. Transportation and storage. Material treatment. Education and entertainment. Computer, scientific and legal Hotels and restaurants Medical, beauty and agricultural Personal American LegalNet, Inc. www.FormsWorkflow.com