SS-4265 (5/16)Business Services DivisionTre Hargett, Secretary of StateState of TennesseeINSTRUCTIONSAPPLICATION FOR NAME CHANGE OF THE TRADEMARK OWNERSUBMISSION OPTIONSPaper submission, Walk-inApplications must be accurately completed in their entirety. Applications that are inaccurate, incomplete or a change in the owner222s name. If there is a change in mark ownership, the Application for Assignment (SS-4262) OWNER NAME CHANGE INSTRUCTIONS1. þ Name of the mark: 2. þ Mark number: 3. þ The original name of the owner of record of the mark:4. þ The new name of the owner:5. þ If the owner222s business entity type has changed, select the new type of business entity type: .6. þ If the owner222s state of incorporation / organization has changed, the new state is: . American LegalNet, Inc. www.FormsWorkFlow.com SIGNATURE AND VERIFICATIONapplication are true and correct.Failure to sign the application will result in the application being rejected.Failure to type or print the signature name and title of the signer will result in the application being rejected.FILING FEE American LegalNet, Inc. www.FormsWorkFlow.com þ þ þ þ þ þ þ APPLICATION FOR NAME CHANGE OF THE TRADEMARK OWNER Business Services DivisionTre Hargett, Secretary of StateState of Tennessee312 Rosa L. Parks Ave., 6th Fl.Nashville, TN 37243(615) 741-0531 In compliance with the requirements of T.C.A. 247 47-25-507, the undersigned hereby submits a change of name for the owner of a trademark or service mark registered in Tennessee:Filing Fee: $20.00 þ þ þ þ þ þ þ *Note: Pursuant to T.C.A. 247 10-7-503 all information on this form is public record.I declare under penalty of perjury the foregoing statements are true and correct. þ (SS-4265) þ þ þ þ þ ) þ þ þ * American LegalNet, Inc. www.FormsWorkFlow.com