This Box For Office Use Only Page 1 of 2 Washington Trademark See attached detailed instructions □ New Filing $55 per classification number □ 5 Year Renewal $50 per classification number □ Add $50 to your fee for Expedited Service 5 Year Expiration Date: Registration Number: TRADEMARK REGISTRATION/RENEWAL Chapter 19.77 RCW SECTION 1 TRADEMARK OWNER: (May be a company, organization or an individual - see instructions page) _______________________________________ Address: ___________________________________________________________________________ City__________________________________ State ______ Zip Code __________ SECTION 2 IF TRADEMARK OWNER IS AN ENTITY LIST STATE/COUNTRY OF ORIGIN: If recorded in the State of Washington, provide the UBI Number: SECTION 3 TRADEMARK SPECIFIC INFORMATION: Attach three (3) samples of the trademark, including one original (see instructions page) Describe the trademark as it is to be registered: Goods or Services Classification Number(s): (see list on page 2): Trademark is used for: □ Goods □ Services of the following description: Trademark – Registration Continued on page 2 Washington Secretary of State Revised 07/10 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 SECTION 3 (continued) Describe the exact manner in which the trademark is affixed to goods or displayed with services: SECTION 4 WASHINGTON TRADEMARK TO BE RENEWED BY APPLICANT Registration Number: Original Date Filed: SECTION 5 DATE TRADEMARK WAS FIRST USED BY APPLICANT OR APPLICANT’S PREDECESSOR Date used in any state or country: Date used in Washington State: SECTION 6 SIGNATURE OF OWNER OR AUTHORIZED REPRESENTATIVE Applicant is the owner of and is now using the trademark identified above; I believe no other individual or entity has the right to use such trademark in connection with the same or similar goods or services in this state either in identical form or in such a near manner as might be mistaken therefore. X __________________________________________________________________________ Signature Printed Name & Title Date Phone Number GOODS OR SERVICE CLASSIFICATION NUMBERS: (See WAC 434-12-015 for a complete description of each classification) Goods 1. Chemical 2. Paints 3. Cosmetic & Cleaning 4. Lubricants & Fuel 5. Pharmaceuticals 6. Metal Goods 7. Machinery 8. Hand tools 9. Electrical & Scientific 10. Medical Apparatus 11. Environmental Control Apparatus 12. Vehicles 13. Firearms 14. Jewelry 15. Musical Instruments 16. Paper Goods & Printed Matter 17. Rubber Goods Trademark – Registration Goods 18. Leather Goods 19. Nonmetallic Building Materials 20. Furniture & Other Articles 21. House wares & Glass 22. Cordage and Fibers 23. Yarns and Threads 24. Fabrics 25. Clothing 26. Fancy Goods 27. Floor Coverings 28. Toys & Sporting Goods 29. Meats & Processed Foods 30. Staple Foods 31. Natural Agricultural Products 32. Light Beverages 33. Wines and Spirits 34. Smoker’s Articles Washington Secretary of State Services 35. Advertising & Business 36. Insurance & Financial 37. Construction & Repair 38. Telecommunications 39. Transportation & Storage 40. Treatment of Materials 41. Education & Training 42. Scientific & Technological 43. Food, Drink & Lodging 44. Medical, Veterinary & Hygienic 45. Personal & Social Revised 07/10 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS – TRADEMARK REGISTRATION/RENEWAL Please complete all sections of the Trademark Registration/Renewal. USE DARK INK ONLY. For an electronic, fillable version of this form, please visit our website at www.sos.wa.gov/corps Registration Number: If available, please enter your existing registration number as currently recorded with the Office of the Secretary of State, in the box in the upper right hand corner of page 1. Section 1 Provide the name and address of the individual, company, or organization that owns the trademark. Section 2 Provide the state or country where the trademark was originally formed. If owner is an entity registered in the State of Washington provide the UBI Number. Section 3  Attached 3 samples of the trademark that can be scanned including one original as currently used, demonstrating that the trademark is in use in commerce; preliminary design artwork is not acceptable.  Provide a detailed description of the trademark, text and/or logo.  Provide the Goods or Services classification number. The number can be found on the attached page.  Indicate if the trademark is used for goods or services.  Describe the exact way the trademark is affixed to goods. For example, is it on letterhead, building signs, included on packages or labels, etc.  FOR RENEWALS ONLY: All descriptions of the trademark, text and/or logo must match that of original filing. Section 4 You must provide current registration number and original file date of the trademark to be renewed. Renewal must be received no later than the date of expiration. If received after expiration date, this filing will be considered a new registration. Trademark renewals are good for a five (5) year period. Section 5 Trademark must be in use in the State of Washington prior to registration. Section 6 Must be signed by an owner or authorized representative. Additional Information: FEES: The filing fee for a new trademark registration is $55.00 per classification. The filing fee for a renewal is $50 per classification. If expedited service is request then add $50 to your total. Mail completed forms and payment to: Secretary of State Corporation Division 801 Capitol Way S PO Box 40234 Olympia WA 98504-0234 If you have questions, need assistance or would like to provide feedback please visit the Corporations Division website at www.sos.wa.gov/corps or call 360-725-0377. Trademark – Registration Washington Secretary of State Revised 07/10 American LegalNet, Inc. www.FormsWorkFlow.com