Filing Fee: $50.00 ID No. ___________ STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS Office of the Secretary of State Corporations Division Trademark Section 148 W. River Street Providence, Rhode Island 02904-2615 APPLICATION FOR THE REGISTRATION OF A TRADEMARK TO BE TYPED-PLEASE READ INSTRUCTIONS BEFORE COMPLETING THIS FORM 1. Name of Applicant _____________________________________________________________________________________________________ 2. (a) Principal business address ____________________________________________________________________________________________ Street _____________________________________________________________________________________________________________________ City/Town State Zip Code (b) Business address in Rhode Island, if any. [To be filled in only if principal business address is not in Rhode Island.] _____________________________________________________________________________________________________________________ Street City/Town State Zip Code 3. State whether applicant is an individual, partnership, corporation, limited liability company, union or association: ________________________________________________________________________________________ 4. If an entity, what is the state of incorporation? _______________________________________________________________________________ 5. Describe mark (1): _____________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ 6. Describe the specific goods in connection with which mark is used: _______________________________________________________________ _____________________________________________________________________________________________________________________ 7. Class No. (2) __________________________________________________________________________________________________________ 8. Check how the mark is used. By applying it: ____ directly to the goods ____ directly to the containers for the goods ____ to tags or labels affixed to the goods ____ to tags or labels affixed to the containers for the goods ____ by displaying it in physical association with the goods in the sale or distribution thereof. 9. Date of the first use of mark by applicant or predecessor. [If first use of mark was in Rhode Island, use same date in both (a) and (b).] (a) Anywhere ________________________________________________________________________________________________________ (b) In Rhode Island ____________________________________________________________________________________________________ 10. If either of the above first uses was by a predecessor of applicant, state which use or uses were by a predecessor and identify the predecessor. _______________________________________________________________________________________ 11. The applicant is the owner of the mark, the mark is in use, and to the best knowledge of the person verifying the application, no other person has registered in this state or has the right to use such mark in this state 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 person, to cause confusion or to cause mistake or to deceive. ________________________________________________________ Name of Applicant _______________________________________________________ Signature of Applicant or Authorized Representative of Applicant STATE OF _________________________ COUNTY OF _______________________ ________________________________________________________ Title In __________________________, on this ____________ day of ________________________, 20___, personally appeared before me ______________________________________________________, who, being by me first duly sworn, declared that he/she signed the foregoing application in the capacity indicated and that the statements contained therein are true, complete and correct. Form No. T-80 Revised: 03/08 ________________________________________________________ Notary Public My commission expires: ___________________________________ American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS AND CLASSIFICATION OF GOODS FOR REGISTRATION OF A TRADEMARK Chapter 6-2 of the General Laws of Rhode Island, 1956, as amended INSTRUCTIONS The application for the registration of a trademark must be accompanied by a filing fee of $50.00. Make all money orders and checks payable to the Secretary of State. Send a separate check for each application. This will prevent the return of multiple applications for correction. All blanks are to be completed before the application will be accepted. If the applicant is a partnership, union, corporation, limited liability company or association, fill in the title or the official capacity of the person signing for such entity. Please include three (3) specimens or facsimiles of the mark with the application on 8 1/2 x 11 inch paper, one specimen per page. DO NOT GLUE, STAPLE OR TAPE. The specimen must demonstrate the use of the mark. Return to: Corporations Division Trademark Section 148 W. River Street Providence, Rhode Island 02904-2615 NOTES (1) State here what applicant believes to be the essential features of the mark. Be as clear as possible. Do not state “See attached.” (2) Section 6-2-9 provides for the promulgation of rules and regulations for the determination of classes of goods. The following general classes of goods are established for convenience of administration of this Chapter but not to limit or extend the applicant’s or registrant’s rights. A single application for registration of a mark may include any or all goods upon which the mark is actually being used and which are comprised in a single class. In no event shall a single application include goods upon which the mark is being used and which fall within different classes. CLASSIFICATION OF GOODS CLASS 1 – Chemicals used in industry, science and photography, 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, 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 – 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; candles, 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 building 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 – 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. American LegalNet, Inc. www.FormsWorkflow.com 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, drying, 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 coated therewith, not included in other classes; jewelry, precious stones; horological and chronometric instruments. CLASS 15 – Musical instruments. CLASS 16 – Paper, cardboard and goods made from these materials, not included in other classes; paper 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 manufacturing; 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 in 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 building; asphalt, pitch and bitumen; nonmetallic transportable buildings; monuments, not of metal. CLASS 20 – 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 – Household or kitchen utensils and containers (not precious metal or coated therewith); combs and sponges; brushes (except paint brushes); brush-making materials; articles for cleaning purposes; steelwool; un-worked or semiworked 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. American LegalNet, Inc. www.FormsWorkflow.com 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, fruit sauces; eggs, milk and milk products; edible oils and fats. CLASS 30 – 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. CLASS 31 – 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 – 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. American LegalNet, Inc. www.FormsWorkflow.com