Certificate Of Renewal Of A Collective Mark

SECRETARY OF THE STATE OF CONNECTICUT MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470 DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106 PHONE: 860-509-6003 WEBSITE: www.concord-sots.ct.gov CERTIFICATE OF RENEWAL OF A COLLECTIVE MARK USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY. FILING PARTY (CONFIRMATION WILL BE SENT TO THIS ADDRESS): FILING FEE: $50 MAKE CHECKS PAYABLE TO "SECRETARY OF STATE" NAME: ADDRESS: CITY: STATE: ZIP: 1. NAME OF APPLICANT/OWNER: 2. STATE OF FORMATION OF THE OWNER (IF OTHER THAN A NATURAL PERSON): 3. NEW ADDRESS OF OWNER (IF APPLICABLE) ADDRESS: CITY: STATE: ZIP: 4. CONNECTICUT REGISTRATION NUMBER: THE OWNER OF THE MARK, WHICH IS THE SUBJECT OF THIS APPLICATION, ASSERTS THAT THE MARK HAS BEEN AND IS STILL IN USE IN CONNECTICUT. THE OWNER HEREBY APPLIES FOR RENEWAL OF THE REGISTRATION BEARING THE NUMBER STATED IN NUMBER 4 ABOVE. 5. EXECUTION - I HEREBY DECLARE UNDER THE PENALTIES OF FALSE STATEMENT THAT THE STATEMENTS MADE IN THE FOREGOING APPLICATION ARE TRUE. DATED THIS NAME OF SIGNATORY DAY OF CAPACITY/TITLE OF SIGNATORY , 20 SIGNATURE THE APPLICANT MUST SUBMIT THREE SPECIMENS OR PHOTOGRAPHS OF THE MARK AS ACTUALLY USED IN THIS STATE. PAGE 1 OF 1 FORM ACM-1-1.0 Rev. 6/2014 American LegalNet, Inc. www.FormsWorkFlow.com