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Trademark Or Servicemark Application For Change Of Name And Or Address Of Registrant TM-SM-35b - Illinois
| Trademark Or Servicemark Application For Change Of Name And Or Address Of Registrant Form. This is a Illinois form and can be used in Trademark Secretary Of State . |
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TM/SM-35b 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 for Change of Name and/or Address of Registrant 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. Recording Fee: $5 See additional page for instructions. 1. Name of Registrant/Owner of the Mark: ______________________________________________________________ (before change) 2. Business Address: Street: Mailing Address: Street: City: State: Zip: City: State: Zip: 3. Registration Number: ------------- Original Date of Registration: ____________________________ MM/DD/YYYY 4. Name of Mark: __________________________________________________________________________________ 5. Name of Registrant/Owner of the Mark:_______________________________________________________________ (after change) 6. Business Address: Street: Mailing Address: Street: City: State: Zip: City: State: Zip: The undersigned hereby declares, under penalties of perjury, that the statements contained in the foregoing application are true. X Signature of Applicant Name of Applicant (type or print) Official Capacity Contact Phone Number Printed by authority of the State of Illinois. October 2012 1 C 293.6 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR NAME/ADDRESS CHANGE APPLICATION [TM/SM-35b] NOTES: · The change of name and/or address for the Registrant/Owner of any Mark must be on a form provided by the Secretary of State. A $5 Recording Fee must accompany the completed application in the form of a check or money order payable to Illinois Secretary of State. The form must be typed, laser-printed or legibly printed in black ink. · · INSTRUCTIONS: 1. Provide the name of the Registrant/Owner of the Mark as it currently appears on the records of the Trademark/Service Mark office (before change). 2. Provide the complete address of the Registrant/Owner of the Mark as it currently appears on the records of the Trademark/Service Mark office (before change). 3. Provide the registration number and the original date of registration as it appears on the records of the Trademark/Service Mark office. 4. Provide the name of the Mark as originally registered. 5. Provide the name of the Registrant as it should appear after the recording of this document. 6. Provide the address for the Registrant as it should appear after the recording of this document. Supporting Documentation: A copy of the supporting document showing the change of name for the Registrant should accompany this application. Signature and Contact Information: The Registrant or the Attorney-in-Fact for the Registrant must sign the form. The capacity in which the person is signing must be given, i.e., Registrant, Officer, Attorney-in-Fact. Duration and Renewal: A certificate indicating the change in name and/or address may be issued for the remainder of the current term of the Mark. American LegalNet, Inc. www.FormsWorkFlow.com
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