Assignment Of Registration Of Trademark Service Mark Certification Mark Or Collective Mark

Office of the Minnesota Secretary of State Assignment of Registration of Trademark, Service Mark, Certification Mark or Collective Mark Minnesota Statutes, Chapter 333 Read the instructions before completing this form. Filing Fee: $35 for expedited service in-person and online filings, $15 if submitted by mail 1. File Number: 3. Mark as Described on Certificate: 2. Class: 4. Name of Present Registrant: Street Address City State Zip The present registrant has filed this mark and is assigning this registration and all rights to and interest in this mark, including any good will connected to the mark for valid consideration which has been received. 5. This Mark is assigned to: Name Street Address Home Jurisdiction, if an organization: City State Zip 6. I, the undersigned, certify that I am signing this document as the person whose signature is required, or as agent of the person(s) whose signature would be required who has authorized me to sign this document on his/her behalf, or in both capacities. I further certify that I have completed all required fields, and that the information in this document is true and correct and in compliance with the applicable chapter of Minnesota Statutes. I understand that by signing this document I am subject to the penalties of perjury as set forth in Section 609.48 as if I had signed this document under oath. Signature or Authorized Person or Authorized Agent Print Name Title Date Email Address for Official Notices Enter an email address to which the Secretary of State can forward official notices required by law and other notices: Check here to have your email address excluded from requests for bulk data, to the extent allowed by Minnesota law. List a name and daytime phone number of a person who can be contacted about this form: Contact Name Phone Number American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS File your business document online by visiting our website at www.sos.state.mn.us. Retain the original signed copy of this document for your records and submit a legible photocopy for filing with the Office of the Secretary of State. A separate assignment is required for each class. 1. Provide the file number issued by the Minnesota Secretay of State 2. Indicate the classification number under which this mark falls. 3. Provide the words, phrase and/or logo description as described on the Certificate of Registration for Trademark issued by this office. 4. List the name and address of the present applicant 5. List the name and address of the individual or organization that the mark has been assigned to. If this is an organization, list the home jurisdiction and the principal place of business in the home jurisdiction. 6. Must be signed by an authorized person or by an authorized agent on behalf of the present registrant (The signing party must indicate on the document that they are acting as the agent of the person(s) whose signature would be required and that they have been authorized to sign on behalf of that person(s).) Email Address for Official Notices. This email address may be used to send annual renewal reminders and other important notices that may require action or response. Check the box if you wish to have your email address excluded from requests for bulk data, to the extent allowed by Minnesota law. List a name and daytime telephone number of a person who can be contacted about this form. Filing Fee: $35 for expedited service in-person and online filings, $15 if submitted by mail Payable to the MN Secretary of State Please submit all items together and mail to the address below: FILE IN-PERSON OR MAIL TO: Minnesota Secretary of State - Business Services Retirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St Paul, MN 55103 (Staffed 8 a.m. ­ 4 p.m., Monday - Friday, excluding holidays) Phone Lines: (9 a.m. - 4 p.m., M-F) Metro Area 651-296-2803; Greater MN 1-877-551-6767 All of the information on this form is public. Minnesota law requires certain information to be provided for this type of filing. If that information is not included, your document may be returned unfiled. This document can be made available in alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing) communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin, age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the provision of service. TrademarkAssignmentRev.7/15/2013 American LegalNet, Inc. www.FormsWorkFlow.com