State of Utah Department of Commerce Division of Corporations & Commercial Code Trademark Registration Information Change Form Non-Refundable Processing Fee: $15.00 Entity File Number: _________________________ Trademark Name: ___________________________________________________________________________________________ For each Yes button that you mark the question will appear below for you to fill out. 1). Do you want to Change the Address of the Trademark's Principal(s)? 1). If Yes, who is the Principal(s) whose Address you wish to Change? You can not change the principal(s) on Trademarks, only the address of the principal(s). If you wish to change the principal(s) you will need to file an Assignment of Utah Trademark. You may find that form on our website at: http://www.corporations.utah.gov/pdfforms/assigtmk.pdf Yes No Name: ___________________________________________________ Position: ______________________________________ Address: __________________________________________________________ City ___________________ State ______ Zip __________ Name: ___________________________________________________ Position: ______________________________________ Address: __________________________________________________________ City ___________________ State ______ Zip __________ Name: ___________________________________________________ Position: ______________________________________ Address: __________________________________________________________ City ___________________ State ______ Zip __________ 2a) Do you want to add a class, replace a class, or change the class of good or service associated with the mark? Yes No Please understand that the class codes you can add are limited, and the limitations are posted at http://www.corporations.utah.gov/goods_services.html. What is the class code you want to change to? _____________________________________________________________________________ Are there additional class codes you would like to add to the trademark? There is an additional $25 fee for each class you add to the trademark. Yes No What is the class code you want to add? _____________________________________________________________________________ What is the class code you want to add? _____________________________________________________________________________ What is the class code you want to add? _____________________________________________________________________________ 2b) Class codes dictated by §70-3a-308, which can be found here: http://le.utah.gov/~code/TITLE70/htm/70_03a030800.htm 3) Do you want to add the date of 1st use outside of Utah? Yes No Please be aware that adding the date of first use outside of UT does not register their mark in which ever State other than UT it was used in, nor can the date precede the date of first use in UT, which unless otherwise specified at the initial registration, is the date the application was received. Date of 1st use: ________________________________ 4a) Do you want to add the information that is from the trademark being federally filed? Filing Date: ________________________ Current Status of the mark: ______________________________ 4b) Has the mark been refused or has otherwise not resulted in a registration? If Yes, list the reason: Yes No Serial Number: ______________________ Yes No _______________________________________________________________________________________________ Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. Under penalties of perjury and as an authorized authority, I declare that this statement of change(s), has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. BY: ___________________________________ Title: __________________________________ Signature of Authorizing Party: ______________________________ Date: _________________________ Mailing/Faxing Information: www.corporations.utah.gov/contactus.html Division's Website: www.corporations.utah.gov American LegalNet, Inc. www.FormsWorkFlow.com