__________________________________________________ (Name of Assignor),
of ___________________________________________________________ (Address) has
adopted and is using a mark for which __________ (He or She) has filed
application in the United States Patent and Trademark Office for registration,
__________________________________________________ (Name of Assignee),
desires to acquire such mark.
consideration of the foregoing, and for other good and valuable consideration,
receipt of which is hereby acknowledged,
________________________________________ (Name of Assignor) does hereby
assign to ____________________________________ (Name of Assignee) all right,
title and interest in and to the mark described herein, together with the good
will of the business symbolized by such mark, and the above-identified
application for registration of such mark.
Commissioner of Patents and Trademarks is requested to issue the certificate of
________________________________________ (Name of Assignee).
of assignor; if assignor is a corporation or other juristic organization, give
official title of person who signs for assignor)
this _____________________ day of _________________ (Month and Year), before me
appeared ____________________________, the person who signed this instrument on
__________ (His or Her) own behalf, or who was authorized to sign this
instrument on behalf of the identified corporation or juristic entity, who
being sworn, acknowledged that __________ (He or She) signed this instrument as
a free act.
of notary public