Assignment Form Trademark Or Service Mark

FORM TM03 (Rev. 6/2019 ) I N COMPLIANCE WITH T HE REQUIREMENTS OF O.C.G.A. 24710 - 1 - 446, THE UNDERSIGNED , HAVING ADOPTED AND USED A T RADEMARK OR S ERVICE M ARK IN THIS STATE FO R PURPOSES PROVIDED IN TH AT C ODE C HAPTER , DOES HEREBY CERTIFY THE FOLLOWING : 1. A SSIGNOR ( C URRENT R EGISTERED O WNER ) 2. P RINCIPAL B USINESS A DDRESS 3. A SSIGNEE (N EW O WNER ) I F AN ENTITY , ENTER STATE OR COUNTRY OF FORMATION : 4. P RINCIPAL B USINESS A DDRESS P RIMARY E MAIL ADDRESS S E CONDARY E MAIL ADDRESS 5. M ARK N AME A . R EGISTRATION N UMBER B . I NITIAL R EGISTRATION D ATE C . E XPIRATION D ATE B E IT KNOWN FOR AND I N CONSIDERATION OF M ONIES , AND / OR OTHER GOOD AND VA LUABLE CONSIDERATION TO IT IN HAND PAID , THE RECEIPT OF WHICH IS HEREBY ACKNOWLED GED , SAID A SSIGNOR DOES HEREBY SELL , AND / OR ASSIGN , AND / OR TRANSFER UNTO SAID A SSIGNEE THE ENTIRE R IGHT , TITLE AND INTEREST IN AND TO THE SAID M ARK AND REGISTRATION THEREOF , TOGETHER WITH THE GOOD WILL OF THE BUSINESS IN W HICH THE MARK IS USE D OR WITH THAT PART OF T HE GOOD WILL OF THE BUSINESS CONNECTED WITH THE U SE OF AND SYMBOLIZED BY THE MARK . S IGNATURE OF A SSIGNOR /O WNER : P RINT OR TYPE NAME : T ITLE ( IF SIGNING FOR ENTIT Y ) : E MAIL : Return this completed form and a $15.00 filing fee to the Secretary of State at the above address before th e expiration date. Fees are non - refundable and non - transferable . OFFICE OF SECRETARY OF STATE CORPORATIONS DIVISION 2 Martin Luther King Jr. Dr. SE Suite 313 West Tower Atlanta, Georgia 30334 (404) 656 - 2817 http://sos.ga.gov/ Secretary of State ASSIGNMENT FORM TRADEMARK OR SERVICE MARK F ILING F EE : $15.00 American LegalNet, Inc. www.FormsWorkFlow.com