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Trademark Or Servicemark Application TM-SM-15 - Illinois
| Trademark Or Servicemark Application Form. This is a Illinois form and can be used in Trademark Secretary Of State . |
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TM/SM-15 Secretary of State Department of Business Services Trademark Division 501 S. Second St., Rm. 330 Springfield, IL 62756 217-524-0400 www.cyberdriveillinois.com State of Illinois Trademark or Service Mark Application Type, Laser Print or Legibly Print in black ink. FILE #: This space for use by Secretary of State. This space for use by Secretary of State. Payment may be made by check or money order payable to Illinois Secretary of State. Registration Fee: $10 See additional page for instructions. Items 1-4 refer to Registrant 1. Name of Registrant/Owner of the Mark:_______________________________________________________________ 2. Business Address: Street: Mailing Address: Street: City: State: Zip: City: State: Zip: 3. Registrant is a (check one): Ë Corporation Ë Union Ë General Partnership Ë Limited Liability Partnership (LLP) Ë Individual Ë Association Ë Limited Partnership (LP) Ë Limited Liability Company (LLC) Ë Other (specify): _______________________________________________________________________________ 4. a) If a Corporation, LP, LLP or LLC, indictate the State in which it is organized: _______________________________ b) If an LP or LLP, Name of one of the General Partners: _________________________________________________ 5. Name of Mark: __________________________________________________________________________________ Mark is a (check one): Ë Word Mark only Ë Word with Design/Logo Ë Design/Logo only If the Mark involves a design/logo, briefly describe major features of the Mark: ________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Printed by authority of the State of Illinois. October 2012 -- 1 -- C 246.10 American LegalNet, Inc. www.FormsWorkFlow.com 6. Describe the specific goods or services in connection with which the Mark is used (provided by the Mark):___________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 7. Classification Number: ____________________ (One classification number only; refer to listing. The Secretary of State will assign a classification number if none is given and has the right to change the classification if that provided by the applicant is incorrect. Each classification requires a separate application, set of three specimens and a $10 filing fee.) 8. a) If a Trademark, check how it is used (check as many as apply). Mark is applied: Ë directly to the goods Ë on documents, wrappers or articles delivered in connection with the service rendered Ë in another fashion; please specify:_____________________________________________________________ OR b) If a Service Mark, check how it is used (check as many as apply). Mark is displayed: Ë in advertisements of the service Ë on documents, wrappers or articles delivered in connection with the service rendered Ë in another fashion; please specify:_____________________________________________________________ 9. Date of first use of Mark by applicant or predecessor. Mark must be used in Illinois prior to registration. (If first use of Mark was in Illinois, use the same date in both a and b.) a) Anywhere: _____________________________________ b) In Illinois: __________________________________ MM/DD/YYYY MM/DD/YYYY 10. State any knowledge of previous owners or users of the mark, including the name of any such owners/users. If there is no knowledge of previous use, please answer N/A. _______________________________________________________ The applicant hereby appoints the Illinois Secretary of State as agent for service of process in an action relating only to the registration, which may be issued pursuant to this application, if the registrant is, or shall become, a non-resident individual, or foreign partnership, limited liability company, association or corporation not licensed to do business in the State, or cannot be found in this State. The undersigned hereby declares, under penalties of perjury, that the statements made in the foregoing application are true, and that to his/her knowledge no other person has registered the Mark, either federally or in this State, or has the right to use the Mark either in the identical form thereof or in such near resemblance thereto as to be likely, when applied to the goods or services of such other person, to cause confusion or to cause mistake, or to deceive. X Signature of Applicant Typed or Printed Name of Applicant Official Capacity Contact Phone Number American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR REGISTRATION APPLICATION [TM/SM-15] NOTES: · · The Mark MUST BE IN USE IN ILLINOIS prior to registration with this office. The application form must be typed, laser-printed or legibly printed in black ink. · The application must be accompanied by three (3) examples of the Mark and the registration fee. Examples should not be stapled, glued or taped to the application. · The $10 Registration Fee must accompany the completed application in the form of a check or money order payable to Illinois Secretary of State. INSTRUCTIONS: 1. Provide the name of the Registrant/Owner of the Mark. The Registrant may be an individual, corporation or other type of registered business entity. Provide the business and mailing addresses. Renewal correspondence will be sent to the mailing address. Mark the appropriate box for the type of ownership, i.e., if the Registrant indicated in item 1 is an individual, then item 3 would be marked individual. Items 4a and/or 4b should be completed ONLY if the Registrant is one of the types of business entities listed in item 3. The name of the Mark must be indicated in this section. One of the options must be clearly indicated. If the Mark does include a design or logo, a brief description of the major features must be provided. Stating "See Attached" is not an acceptable response. A description of the goods or the services provided by the Mark must be provided. A Trademark represents the name of a product or product line, or a logo or tagline for the product or product line. A Service Mark represents the name of a business that p
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