SS-4263 (6/13) Business Services Division Tre Hargett, Secretary of State State of Tennessee INSTRUCTIONS APPLICATION FOR RENEWAL OF TRADEMARK OR SERVICE MARK SUBMISSION OPTIONS Applications may be filed using one of the following methods: · Paper submission: A blank application may be obtained by going to http://www.tn.gov/sos/forms/ss-4263.pdf, by emailing the Secretary of State at Business.Services@tn.gov, or by calling (615) 741-0531. The application must be hand printed in ink or computer generated and mailed along with the required filing fee to the Secretary of State's office at 6th FL ­ Snodgrass Tower ATTN: Trademarks, 312 Rosa L. Parks AVE, Nashville, TN 37243. Walk-in: A blank application may be obtained in person at the Secretary of State Business Services Division located at 6th FL ­ Snodgrass Tower, 312 Rosa L. Parks AVE, Nashville, TN 37243. · Applications must be accurately completed in their entirety. Applications that are inaccurate, incomplete or illegible will be rejected. APPLICANT INFORMATION 1. Applicant Name: Enter the name of the person or entity applying for the renewal of the trademark or service mark. 2. Applicant Address: Enter the complete business address of the person or entity applying for the renewal of the trademark or service mark. The address must include a street address or post office box (or both), city, state and zip code. Please include a phone number so that you may be contacted if there are questions regarding your application. 3. Date of original registration: Indicate the filing date of the mark's original registration. 4. Name and description of the mark in words: This description of what the mark looks like must match ­ word for word ­ the description found in the mark's original application. 5. The mark has been and is still in use in Tennessee: By signing the application, the applicant certifies that this statement is true. 6. One specimen showing the mark as actually used accompanies this application: The applicant must provide three specimens of the mark in use along with the application. By signing the application, the applicant certifies that this statement is true. American LegalNet, Inc. www.FormsWorkFlow.com Failure to include three specimens will result in the rejection of the application. A specimen must establish that the mark currently is in use in commerce in Tennessee. Specimens should not be larger than 8 ½ inches by 11 inches and should be flat. Small specimens, such as tags or labels, may be taped or pasted to a sheet of paper and labeled "SPECIMEN". For trademarks, examples of acceptable specimens are tags or labels that are attached to the goods, containers for the goods, displays associated with the goods, or photographs of the goods showing use of the mark of the goods themselves. Invoices, announcements, order forms, bills of lading, leaflets, brochures, catalogs, publicity releases, letterhead and business cards may be acceptable specimens for trademarks if they sufficiently demonstrate that the mark is being used with the goods. If it is impractical to send actual specimens because of its size, photographs or other acceptable reproductions that show the mark on the goods, or packaging for the goods, must be furnished. For service marks, examples of acceptable specimens are signs, brochures about the services, advertisements for the services, business cards or stationery showing the mark in connection with the services, or photographs that show the mark either as it is used in the rendering or advertising of the services. The specimen must either show the mark and include some clear reference to the type of services rendered under the mark in some form of advertising, or show the mark as it is used in the rendering of the service (for example, on a store front or the side of a delivery truck). 7. The applicant is the owner of the mark, and the mark is in use. To the knowledge of the person verifying this application, no other person has registered, either federally or in Tennessee, or has the right to use the mark in an identical form or in such near resemblance as to be likely, when used on or in connection with the goods or services of the other person, to cause confusion or mistake, or to deceive: By signing the application, the applicant certifies that this statement is true. SIGNATURE AND NOTARIZATION · This application must be signed by the applicant. Failure to sign the application will result in the application being rejected. Type or Print Name & Title. Failure to type or print the signature name and title of the signer (if the applicant is a business entity) will result in the application being rejected. Notarization ­ The renewal application must be duly notarized by an active notary public. Notarization must be on the actual application, and not on a separate sheet of paper. An application submitted without proper notarization will result in the application being rejected. FILING FEE · The filing fee for the application is $20.00 per Class for which the mark had been previously registered. If there is only one (1) class indicated the fee is $20.00. If there are two (2) classes indicated, the fee is $40.00, etc. Make check, cashier's check or money order payable to the Tennessee Secretary of State. Cash is only accepted for walk-in filings. Applications submitted without the proper filing fee will be rejected. · · · American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR RENEWAL OF TRADEMARK OR SERVICE MARK (SS-4263) Tre Hargett, Secretary of State State of Tennessee 312 Rosa L. Parks Ave., 6th Fl. Nashville, TN 37243 (615) 741-0531 Business Services Division For Office Use Only Filing Fee: $20.00 per class In compliance with the requirements of T.C.A. § 47-25-506, the undersigned hereby applies for renewal of a previously registered trademark or service mark and hereby certifies under oath and penalty of perjury the following statements: 1. Applicant Name: 2. Applicant Address: City: Phone #: 3. Date of original registration: Month / Day / Year State: Zip Code: 4. Name and description of the mark in words: 5. The mark has been and is still in use in Tennessee. 6. One specimen showing the mark as actually used accompanies this renewal application. 7. The applicant is the owner of the mark, and the mark is in use. To the knowledge of the person verifying this application, no other person has registered, either federally or in Tennessee, or has the right to use the mark in an identical form