Corporations Division PO Box 40234 Olympia, WA 98504 Phone 360-725-0377 FOR OFFICE USE ONLY ASSIGNMENT OF REGISTRATION OF TRADEMARK RCW 19.77.060 1. Registration Number______________________ Original Date Filed:____________________ 2. Describe mark exactly as it is on Certificate of Registration of Trademark: ___________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 3. Classification number exactly as it is on Certificate of Registration of Trademark: _____________ 4. Name of Present Registrant:________________________________________________________ Address of Present Registrant_______________________________________________________ Expiration Date of Present Registration: ______________________________________________ The present registrant has filed this mark and is assigning this registration and all rights to and interest in this mark, including any good will connected to the mark for valid consideration which has been received. 5. Mark is assigned to: _______________________________________________________________ Address: _______________________________________________________________________ State of incorporation, if a corporation: _______________________________________________ 6. Signature of Present Registrant: Date: _________ Signature ______________________________ Title____________________________ County of ____________________________) ss State of ______________________________) I, _____________________________ a notary public, do certify that on this ______day of _________. 20____, personally appeared before me, _____________________________, who being by me first duly sworn, signed the foregoing instrument in my presence, and that the allegations contained therein are true. (SEAL) Signed:_________________________________________ My commission expires: ___________________________ TMAssign 02/08 American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Application for Assignment of Registration of Trademark RCW 19.77.060 (Copies of the Revised Code of Washington law may be obtained at local and state libraries) CHECK LIST All documents must be typewritten or printed legibly in ink. 1. Enter registration number of and original date that the existing trademark was filed. 2. Describe the trademark exactly as it appears on Certificate of Registration of Trademark. 3. Enter classification number as it appears on Certificate of Registration of Trademark. 4. Enter name, address of present registrant and expiration date of current trademark registration. 5. Enter name and address of applicant to whom the trademark is being assigned. If assignee is a corporation, give the state where it is incorporated. 6. Signature of present registrant who is releasing trademark to assignee. Must be signed by a notary public PAYMENT REQUIREMENTS Filing fee is $10.00 (Make check payable to Secretary of State) There is an additional $5.00 fee required if a new certificate is requested. The original Application for Assignment must be delivered or mailed to: Corporations Division Office of the Secretary of State 801 Capitol Way South PO Box 40234 Olympia, WA 98504-0234 Call 360-725-0377 American LegalNet, Inc. www.FormsWorkFlow.com