PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Application for Registration of Trademark or Service 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 trademark 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 (see instruction B): 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 and set forth in instruction G): American LegalNet, Inc. www.FormsWorkFlow.com DSCB:54-1112– 2 5. The goods or services on or in connection with which the mark is used and the mode or manner in which the mark is used on or 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, the mark is in use and, 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 to be executed this day of , . _________________________________________ Name of Applicant _________________________________________ Signature _________________________________________ Title Rev 11/2010 American LegalNet, Inc. www.FormsWorkFlow.com DSCB:54-1112-3 Department of State Bureau of Corporations and Charitable Organizations 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. The name of a commercial registered office provider may not be used in Paragraph 2 in lieu of an address. C. 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, as listed in G below). D. 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. 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. G. Schedule of classes of goods and services GOODS CLASS 1 – Chemicals Chemicals used in industry, science and photography, as well as in agriculture, horticulture and forestry; unprocessed artificial resins, unprocessed plastics; manures; fire extinguishing compositions; tempering and soldering preparations; chemical substances for preserving foodstuffs; tanning substances; adhesives used in industry. CLASS 2 – Paints Paints, varnishes, lacquers; preservatives against rust and against deterioration of wood; colorants; mordants; raw natural resins; metals in foil and powder form for painters, decorators, printers and artists. CLASS 3 – Cosmetics and cleaning preparations Bleaching preparations and other substances for laundry use; cleaning, polishing, scouring and abrasive preparations; soaps; perfumery, essential oils, cosmetics, hair lotions; dentifrices. CLASS 4 – Lubricants and fuels Industrial oils and greases; lubricants; dust absorbing, wetting and binding compositions; fuels (including motor spirit) and illuminants; candles and wicks for lighting. CLASS 5 – Pharmaceuticals Pharmaceutical and veterinary preparations; sanitary preparations for medical purposes; 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. American LegalNet, Inc. www.FormsWorkFlow.com CLASS 6 – Metal goods Common metals and their alloys; metal building materials; transportable buildings of metal; materials of 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 – Machinery Machines and machine tools; motors and engines (except for land vehicles); machine coupling and transmission components (except for land vehicles); agricultural implements other than hand-operated; incubators for eggs. CLASS 8 – Hand tools Hand tools and implements (hand-operated); cutlery; side arms; razors. CLASS 9 – Electrical and scientific apparatus Scientific, nautical, surveying, photographic, cinematographic, optical, weighing, measuring, signaling, checking (supervision), life-saving and teaching apparatus and instruments; apparatus and instruments for conducting, switching, transforming, accumulating, regulating or controlling electricity; 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; fireextinguishing apparatus. CLASS 10 – Medical apparatus Surgical, medical, dental and veterinary apparatus and instruments, artificial limbs, eyes and teeth; orthopedic articles; suture materials. CLASS 11 – Environmental control apparatus Apparatus for lighting, heating, steam generating, cooking, refrigerating, drying, ventilating, water supply and sanitary purposes. CLASS 12 – Vehicles Vehicles; apparatus for locomotion by land, air or water. CLASS 13 – Firearms Firearms; ammunition and projectiles; explosives; fireworks. CLASS 14 – Jewelry Precious metals and their alloys and goods in precious metals or coated therewith, not included in other classes; jewelry, precious stones; horological and chronometric instruments. CLASS 15 – Musical Instruments CLASS 16 – Paper goods and printed matter Paper, cardboard 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); printers' type; printing blocks. CLASS 17 – Rubber goods 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 goods Leather and imitations of leather, and goods made of these materials and not included in other classes; animal skins, hides; trunks and travelling bags; umbrellas, parasols and walking sticks; whips, harness and saddlery. CLASS 19 – Nonmetallic building materials Building materials (non-metallic); non-metallic rigid pipes for building; asphalt, pitch and bitumen; non-metallic transportable buildings; monuments, not of metal. CLASS 20 – Furniture and articles not otherwise classified Furniture, mirrors, picture frames; goods (not included in other classes) of wood, cork, reed, cane, wicker, horn, bone, ivory, whalebone, shell, amber, mother-of-pearl, meerschaum and substitutes for all these materials, or of plastics. CLASS 21 – Housewares and glass Household or kitchen utensils and containers; combs and sponges; brushes (except paint brushes); brush-making materials; articles for cleaning purposes; steelwool; unworked or semi-worked glass (except glass used in building); glassware, porcelain and earthenware not included in other classes. CLASS 22 – Cordage and fibers 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 Yarns and threads for textile use. CLASS 24 – Fabrics Textiles and textile goods, not included in other classes; bed and table covers. CLASS 25 – Clothing Clothing, footwear, headgear. CLASS 26 – Fancy goods Lace and embroidery, ribbons and braid; buttons, hooks and eyes, pins and needles; artificial flowers. CLASS 27 – Floor coverings Carpets, rugs, mats and matting, linoleum and other materials for covering existing floors; wall hangings (non-textile). CLASS 28 – Toys and sporting goods Games and playthings; gymnastic and sporting articles not included in other classes; decorations for Christmas trees. CLASS 29 – Meats and processed foods Meat, fish, poultry and game; meat extracts; preserved, frozen, dried and cooked fruits and vegetables; jellies, jams, compotes; eggs, milk and milk products; edible oils and fats. CLASS 30 – Staple foods Coffee, tea, cocoa, sugar, 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 (condiments); spices; ice. American LegalNet, Inc. www.FormsWorkFlow.com CLASS 31 – Natural agricultural products Agricultural, horticultural and forestry products and grains not included in other classes; live animals; fresh fruits and vegetables; seeds, natural plants and flowers; foodstuffs for animals, malt. CLASS 32 – Light beverages Beers; mineral and aerated waters and other non-alcoholic drinks; fruit drinks and fruit juices; syrups and other preparations for making beverages. CLASS 33 – Wine and spirits Alcoholic beverages (except beers). CLASS 34 – Smokers’ articles Tobacco; smokers' articles; matches. SERVICES CLASS 35 – Advertising and business Advertising; business management; business administration; office functions. CLASS 36 – Insurance and financial Insurance; financial affairs; monetary affairs; real estate affairs. CLASS 37 – Building construction and repair Building construction; repair; installation services. CLASS 38 – Telecommunications CLASS 39 – Transportation and storage Transport; packaging and storage of goods; travel arrangement. CLASS 40 – Treatment of materials CLASS 41 – Education and entertainment Education; providing of training; entertainment; sporting and cultural activities. CLASS 42 – Computer and scientific Scientific and technological services and research and design relating thereto; industrial analysis and research services; design and development of computer hardware and software. CLASS 43 – Hotels and restaurants Services for providing food and drink; temporary accommodation. CLASS 44 – Medical, beauty and agricultural Medical services; veterinary services; hygienic and beauty care for human beings or animals; agriculture, horticulture and forestry services. CLASS 45 – Personal Legal services; security services for the protection of property and individuals; personal and social services rendered by others to meet the needs of individuals. 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