CORPORATION
APPLICATION
PRINCIPAL
REGISTER--WITH DECLARATION
REGISTRATION
OF TRADEMARK IN THE UNITED STATES PATENT AND TRADEMARK OFFICE
Mark
_______________________________________
Class
Number ________________________________
TO
THE COMMISSIONER OF PATENTS AND TRADEMARKS:
____________________________________________________
(Corporate Name)
_________________________________________
(State or Country of Incorporation)
______________________________________________________
(Business Address)
The
above identified applicant has adopted and is using the trademark shown in the
accompanying drawing for ______________________________________________
(common, usual or ordinary name of goods) and requests that such mark be
registered in the United States Patent and Trademark Office on the Principal
Register established by the Act of July 5, 1946.
The
trademark was first used on the goods on __________ (Date); was first used in
_____________________________________________________ (Type of Commerce)
commerce on __________ (Date); and is now in use in such commerce.
The
mark is used by applying it to __________________________________________
(manner of application, such as the goods or labels affixed to the
__________________ (product)). Five
specimens showing the mark as actually used are presented herewith.
(Power
of attorney may be inserted at this point in the application or may be on a
separate sheet. If power of attorney to
be part of application, add:
POWER
OF ATTORNEY
Applicant
hereby appoints _______________________________________________
______________________________ (Names(s)), of __________________________
_____________________________________________________________(Address),
_________________________ (an attorney or attorneys at law or other title, such
as: secretary of the applicant
corporation) to prosecute this application to register, to transact all
business in the Patent and Trademark Office in connection therewith, and to
receive the certificate of registration).
DECLARATION
_____________________________________________
(Name of Corporate Officer), being hereby warned that willful false statements
and the like are punishable by fine or imprisonment, or both, under Section
1001 of Title 18 of the United States Code and that such willful false
statements may jeopardize the validity of the application or any registration
resulting from it, declares that:
1. __________ (he or she) is __________________________________
(Official Title) of applicant corporation and is authorized to execute this
instrument on behalf of the corporation;
2. __________ (he or she) believes the
corporation to be the owner of the trademark sought to be registered;
3. To the best of __________ (his or her)
knowledge and belief no other person, firm, corporation or association has the
right to use the mark in commerce, either in the identical form or in such near
resemblance to it as may be likely, when applied to the goods of such other
person, to cause confusion or mistake, or to deceive;
4. All statements made in this application of
____________ (his or her) own knowledge are true and all statements made on
information and belief are believed to be true; and
5. These statements were made with the
knowledge that willful false statements and the like so made are punishable by
fine or imprisonment, or both, under Section 1001 of Title 18 of the United
States Code and that such willful false statements may jeopardize the validity
of the application or document or any registration resulting therefrom.
__________________________________________________________
Corporate
name
By:
_______________________________________________________
Signature
of corporate officer and official title
(Attach
designation of domestic representative, if necessary).
