Filing Fee: $50.00 Office of the Secretary of State Corporations Division Trademark Section 148 W. River Street Providence, Rhode Island 02904-2615 ID No. ___________ STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS 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. ________________________________________________________ Notary Public My commission expires: ___________________________________ American LegalNet, Inc. www.FormsWorkflow.com Form No. T-80 Revised: 03/08 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, decorat