A r k ansas Secr e t a ry of St at e State Capitol • Little Rock, Arkansas 72201-1094 501-682-3409 • www.sos.arkansas.gov Charlie Daniels TRADEMARKS AND SERVICE MARKS APPLICATION OR RENEWAL 1.  New Application  Renewal (PLEASE PRINT OR TYPE) FOR OFFICE USE ONLY File Number: Expiration Date: 2. Applicant’s Name: Street Address: City: State: ZIP: 3. If Applicant is a corporation, give state of incorporation: If Applicant is a Partnership, give state of organization and names of general partners: 4. Applicant Is Seeking to Register:  Trademark  Service Mark 5. What is the classification and title of goods and services connected with mark: 6. Briefly describe the goods and services used in connection with this mark: 7. Briefly describe how the mark is used in connection with such goods and services: 8. Mark being applied for is (Include 3 Specimens): 9. The mark has been used in business by the applicant (or predecessor) since since . Federal Trademark if applicable and used in the state of Arkansas . AFFIDAVIT Applicant is stating that said applicant is the owner of the mark and that no other person has registered, either federally or in this State, or has the right to use the mark in this State either in the identical form thereof or in such a near resemblance thereto as might be calculated to deceive or to be mistaken therefor. 10. I, , being first duly sworn, state that I am the applicant, or a lawfully authorized representative of the applicant, that I have read the above application and know its contents and that the facts stated therein are true: Signature Title Printed Name Contact Telephone Number 11. State of Arkansas County of Subscribed and sworn to before me, a notary public, on this day of My commission expires: Filing Fee $50.00 , . Notary Public Rev. 7/05 American LegalNet, Inc. www.USCourtForms.com