ASSIGNMENT OF MARKS FORM (Pursuant to s. 132.01(9), Wis. Stats.) FILING FEE: $15.00 Make check payable to “Department of Financial Institutions”. 1. ASSIGNOR (present registrant): ____________________________________________ 2. ADDRESS OF ASSIGNOR: _______________________________________________ ________________________________________________________________________ 3. ASSIGNEE (party acquiring registration) STATE FULL EXACT NAME: ________________________________________________________________________ 4. IDENTIFY ASSIGNEE (for example, sole proprietor, corporation, unincorporated business, bank, limited liability company, partnership, association, etc.): ________________________________________________________________________ NOTE: If assignee is required to be licensed or registered with any government office, attach copies of the most recent registration documents. Copies are not necessary if the assignee’s documents are on file in the Corporations Section of the Department of Financial Institutions of Wisconsin. For-profit foreign corporations must be qualified to do business in Wisconsin before this assignment can be recorded. 5. ADDRESS OF ASSIGNEE: _______________________________________________ _________________________________________Telephone: _____________________ NOTE: The certificate of assignment will be mailed to the above address, unless another is specified here: ______________________________________________________________________________________ 6. IDENTIFY MARK TO BE ASSIGNED: ________________________________________________________________________ ________________________________________________________________________ 7. REGISTRATION FILING NUMBER AND/OR DATE OF ORIGINAL FILING: ________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 8. ASSIGNOR MUST SIGN IN THE PRESENCE OF A NOTARY PUBLIC: I, the undersigned, being duly sworn, state that: the assignor (present registrant) has adopted and used in the assignor’s business the mark identified in paragraph 6 above and has registered the same in the Department of Financial Institutions of State of Wisconsin; the above, the business to which such registration pertains; the assignor hereby assigns to said assignee all right, title and interest in an to said registration; that I am the assignor as identified in paragraph 1 above, or am duly authorized by such assignor to execute this assignment on behalf of the assignor. ASSIGNOR sign here: _______________________________________________________ Print name and title: __________________________________________________________ State of: _______________________________ County of: _____________________________ Subscribed and sworn to before me on this date: __________________________ Notary’s signature: __________________________________________________ Print notary’s name as signed: _________________________________________ My commission expires: _____________________________________________ Notary must Affix Notarial Seal/Stamp Office Location 345 W. Washington Ave., 3rd Floor Madison, WI 53703 Mailing Address Department of Financial Institutions Trademark Records PO Box 7847 Madison, WI 53707-7847 Telephone: (608) 266-8915 Website: http://www.wdfi.org American LegalNet, Inc. www.FormsWorkFlow.com