For Office Use Only Wyoming Secretary of State 2020 Carey Avenue, Suite 700 Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: Business@wyo.gov TN-Cancellation - Revised October 2015 Cancellation of Trademark 1.Trademark to be cancelled: 2.Trademark which is registered with the Secretary of State, Registration Number 3.Trademark was registered with the Secretary of State222s Office on: (Date 226 mm/dd/yyyy) 4.I, hereby cancel registration of this trademark. (Registrant of the trademark) Registrant Signature: Date: (mm/dd/yyyy) Print Name: Contact Person: Title: Daytime Phone Number: Email: (Email provided will receive evidence) *May list multiple email addresses Checklist Filing Fee: $10.00 Make check or money order payable to Wyoming Secretary of State. Please submit one originally signed document. Typical processing time is 3-5 business days following the date of receipt in our office. Please review form prior to submitting to the Secretary of State to ensure all areas have been completed to avoid a delay in the processing of your documents. American LegalNet, Inc. www.FormsWorkFlow.com