APPLICATION FOR ASSIGNMENT OF TRADEMARK/SERVICE MARK STATE OF NEW MEXICO
This form may only be used to record the assignment of a trademark/service mark. 1. 2. 3. 4. Name of assignor: Name of assignee: Business address of assignee: If assignee is a partnership, enter the state in which partnership is organized and the full and complete names of the general partners:_____________________________________________________________
5. 6. 7. 8. 9.
If assignee is a corporation or limited liability company, enter state of incorporation: Name, address, and phone number of contact person for assignee: File number of the trademark/service mark being assigned: Name of trademark/service mark being assigned: Date of assignment: __________________________________________________ ( )
Phone
10. Person, mailing address and phone number if different from above:
I hereby swear or affirm under penalty of perjury that the information provided is true, correct and complete and further that I registered in the State of New Mexico the trademark/service mark identified above, and transferred all rights and interest in the trademark/service mark to the assignee named herein. By:N
Please Print Assignor’s Full Name Assignor Signature and Title
I hereby swear or affirm under penalty of perjury that I have adopted and am now using in the State of New Mexico the trademark/service mark identified above. By:
Please Print Assignee’s Full Name Assignee Signature and Title
Submit application and $25.00 recording fee to: Office of the Secretary of State 325 Don Gaspar, Suite 301 Santa Fe, New Mexico 87503
Form TK4 (October 2003)