Application For Registration Of Insignia {602}

CSCL/CD-602 (Rev. ) MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRSCORPORATIONS, SECURITIES & COMMERCIAL LICENSING BUREAU Date Received (FOR BUREAU USE ONLY) INSIGNIA IDENTIFICATION NUMBER APPLICATION FOR REGISTRATION OF INSIGNIA(Please read information and instructions on next page)Pursuant to the provisions of Act 281, Public Acts of 1927, the undersigned executes the following Application: 1.The name of the association, lodge, order, society, union or other entity applying for the registration is:2.The business address of the applicant named in Item 1 is: 3.Application is made to register a:4.Describe the badge, button, decoration, charm, name, emblem, rosette or other insignia including lettering styles, colors,words, etc. which are an inherent part of the insignia: (enter one of the following words: badge, button, decoration, charm, name, emblem, rosette or identify other insignia) 5.The registration shall be for the use, benefit and on behalf of all associations, degrees, branches, subordinate lodges andauxiliaries of said association, lodge, order, fraternal society, beneficial association, or fraternal and beneficial society orassociation, historical, military or veteran's organization, labor union, foundation, federation, or any other society,organization or association, degree, branch, subordinate lodge or auxiliary thereof and the individual members and thosewho thereafter become members thereof, throughout the State of Michigan.This application is executed this day of, by the chief officer or officersof the application acting in an official capacity for the applicant. (Signature)(Signature)(Signature)(Type or Print Name)(Type or Print Name)(Type or Print Name) American LegalNet, Inc. www.FormsWorkFlow.com CSCL/CD-602 (Rev. Preparer's NameBusiness telephone number ( ) Submit with check or money order by mail: Michigan Department of Licensing and Regulatory Affairs Corporations, Securities & Commerical Licensing Bureau Corporation Division P.O. Box 30054 Lansing, MI 48909To submit in person:2501 Woodlake CircleOkemos, MI 48864Telephone: (517) 241-6470 Fees may be paid by check, money order, VISMasterard when delivered in person to our office. LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are availableupon request to individuals with disabilities. INFORMATION AND INSTRUCTIONS Submit one original of this document. Upon filing, a Certificate of Registration will be mailed to the applicant or his/herrepresentative to the address provided on this Application. Since this document will be maintained on electronic format, it is important that the filing be legible. Documents with poor blackand white contrast, or otherwise illegible, will be rejected. This Application is to be used pursuant to Act 281, P.A. of 1927, by an association, lodge, order, fraternal society, beneficialassociation, fraternal and beneficial society or historical association, historical, military or veterans' organization, labor union,foundation, federation or any other society, organization, or association, degree, branch, subordinate lodge or auxiliary thereoffor the purpose of registering its name, badge, button, decoration, charm, emblem, rosette, or other insignia. A facsimile, duplicate or copy of the item being registered must accompany this form. The sample should be 8.5 x 11 inches orsmaller so it may be scanned to optical disk media. Item 4 - Describe the insignia as fully as possible including any design or pictorial features. If extra space is needed, continueon an attachment. This application must be signed in ink by the chief officer or officers of the applicant. FEE: Make remittance payable to the State of Michigan................................................................................................$5.00 American LegalNet, Inc. www.FormsWorkFlow.com