1 DFI/TRD103 (04/19) S tate of Wisconsin 226 Department of Financial Institutions CANCELLATION of Tradename/Trademark Per Chapter 132 Wisconsin Statutes OFFICE USE ONLY Received Date: Original File Date: Trademark/name ID: 1. Effective date of cancellation Month(MM) Day(DD) Year (YYYY) 2 . Applicant Name currently associated with t he Trademark/Tradename 3. R egistration ID 4 . Street address City State Zip 5 . M ailing address (if different from street address ) City State Zip 6. Tradename or Trademark currently registered 7 . Contact person or authorized party Email Phone 8. I, the undersigned, am the registrant, owner, officer or representative who is authorized to submit the cancellation for the registered Trademark or Tradename. Signat ure Printed Name Title This document can be made available in alternate formats, upon request, to qualifying individuals with disabilities. Address: Trademark Section Contact Information: Department of Financial Institutions Phone: 608-266-8915 Mail to: PO Box 7847 Fax: 608-264-7965 Madison WI 53707-7847 Email: DFI-Trademark@dfi.wisconsin.gov Courier: 4822 Madison Yards Way, North Tower TTY: 711 Madison WI 53705 American LegalNet, Inc. www.FormsWorkFlow.com 2 DFI/TRD103 (04/19) Cancellation of Trademark/Tradename Instructions 1. Enter the effective date of the cancellation of the tradename/trademark. 2. Enter the full legal name of the entity (sole proprietor, corporation, LLC, partnership, etc.) that registered the tradename/trademark. 3. Enter the Registration ID of the Tradename/Trademark you are cancelling. To find this number, search for your Tradename/Trademark on our website https://dccs.wdfi.org 4. Enter the street address of the entity which registered the tradename/trademark. 5. Optional 226 Enter the mailing address if is different from the address in #3. 6. Enter the Trademark or Tradename that is currently registered. 7. Provide the contact information for the person or authorized party who will respond to correspondence regarding this cancellation. 8. Clearly print your name and title and apply your signature. 9. There is no fee required to submit a cancellation. 10. Your information will be updated on https://dccs.wdfi.org . Contact us if you notice any discrepancies and/or have questions. Email: DFI-Trademark@dfi.wisconsin.gov Phone: 608-266-8915 American LegalNet, Inc. www.FormsWorkFlow.com