S tate of Wisconsin 226 Department of Financial Institutions Assignment of Tradename/Trademark Per Chapter 132 Wisconsin Statutes OFFICE USE ONLY 1. Assignor (N ame of original registrant) 2. of Original Registration 3 . Assignor B usiness Address City State Zip 4.Exact name or phrase to be assigned. If assigning a design/logo/mark, please provide a written description and include an example.If Tradename: Enter name (or phrase) to be registered.If Trademark: Provide a picture and description using detailed language so that a person would be able to get a good image of the design without actually seeing the design. If more space is needed, include an additional page for the description. 5.Assignee (Name of entity acquiring the Tradename or Trademark ) 6 .Assignee Business Address City State Zip 7.Assignee Email Address (to be used to email the certificate and confirmation) Phone 8 .Certificate mailing add ress (if diffe rent from Assignee Business Address ) City State Zip 9.I, the undersigned, swear or affirm that I amthe registrant or a duly authorized representativeof the registrant for the tradename or trademarkidentified in line 4 above, and that this tradenameor trademark is hereby assigned to the assigneeidentified in line 5 above. 10.Affix notary seal or stamp AssignorSignature (to be signed in the presence of a Notary) Subscribed and sworn to before me on this date/state/county Date State County Printed Name Notary Signature Title Commission Expiration Date 11 .Contact person Email Phone This document can be made available in alternate formats, upon request, to qualifying individuals with disabilities. Attention: Mail to: Physical Location: Tradename/Trademark Section Department of Financial Institutions PO Box 7847 Madison WI 53707-7847 4822 Madison Yards Way Madison WI 53705 Contact Information: Phone: 608-266-8915 Email: DFI-Trademark@dfi.wisconsin.gov Fax: 608-264-7965 TTY: 711 Assignment is effective through the expiration date of the original registration. Filing fee is $15.00 226 Make checkspayable to WDFI. DFI/TRD102 (04/19) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Assignment of Tradename/Trademark Instructions The registration of a Tradename/Trademark may be "assigned" to another entity during the 10 year period that the original registration is active. 1.Enter the full name of the business that registered the tradename/trademark.Sole proprietors, enter the first and last name.Example: Jill Wilson Anderson, John Johnson Jr. For corporations, LLCs, partnerships, etc., enter the registered name of the business.Examples: XYZ LLC, Lake Woods Association, M & P Partnership. 2.You can find this number when you search for your Tradename/Trademark on our websitehttps://dccs.wdfi.org . If you cannot find the number, leave this field blank. 3.Enter the business address of the applicant entered in #1.4.Enter the Tradename/Trademark you are assigning. This should be the same as what wassubmitted for the original filing.5.Enter the name of the business owner that will be assigned the tradename/trademark (assignee).Sole proprietors, enter the first and last name.Example: Mark Anderson III, Ann Smith For corporations, LLCs, partnerships, etc., enter the registered name of the business.Examples: JBA LLC, Sidewalk Association, Smith & Jones Partnership 6.Enter the business address of the entity entered in #5.7.Optional - Enter the Certificate email address and/or phone number. If you want the Certificatemailed, you should leave #7 blank.8.Optional - If the certificate should be mailed to a location that is different from the registrant222saddress in #6, enter the mailing address.9.Print your name and title and sign in the presence of a notary.10.Notary must complete this section in its entirety.11.Enter the contact name, email and phone number of the person who can answer questions aboutthis application.12.Submit $15.00 payment for each name/design assigned, and mail the form(s) to the address listedat the bottom of the registration form. If applying for multiple names/designs, submit a separateapplication for each name/design.13.When the application is completely processed you will receive a Tradename/Trademark Certificateand confirmation by mail or email and the information will be posted on our website athttps://dccs.wdfi.org . Email: DFI-Trademark@dfi.wisconsin.gov Phone: 608-266-8915 DFI/TRD102 (04/19) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com