State of Illinois Trademark or Servicemark
Application
Complete and return with $10 fee and three specimens to: Secretary of State Department of Business Services Trademark Division 3rd Floor, Howlett Building Springfield, IL 62756 217-524-0400 www.cyberdriveillinois.com Must be typewritten or legibly printed in black ink. This application must be accompanied by three specimens of the mark and a $10 filing fee payable to the Secretary of State. Please paperclip specimens to the application. DO NOT GLUE OR STAPLE. Send a separate check for each application. This will prevent the return of multiple applications for correction.
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Items 1-4 refer to Registrant 1. Name of Registrant (Owner of the Mark) 2. Mailing Address
City, State, ZIP Code Street
3. Is Registrant a (check one) Ë Corporation Ë Union Ë Individual Ë Association Ë Other (specify)
Ë General Partnership Ë Limited Partnership (LP)
Ë Limited Liability Partnership (LLP) Ë Limited Liability Company (LLC)
4. a) If a Corporation, LP, LLP or LLC, in what state is it organized? b) If an LP or LLP, what is the name of one of the general partners?
5. Name of mark Does the mark involve a design or logo? Ë Yes If yes, briefly describe major features of design
Ë No
6. Describe the specific goods or services in connection with which mark is used (provided by the mark)
7. Class No. (One classification number only; classes are listed on the back. The Secretary of State will fill in the answer if no answer is given and has the right to change the classification if that furnished by the applicant is not correct. Each classification requires a separate application, set of three specimens and fee.)
Printed by authority of the State of Illinois. May 2005 — 2M — C 246.5
8. a) If a Trademark, check how the mark is used (check as many as apply). Mark is applied: Ë directly to the goods Ë on documents, wrappers or articles delivered in connection with the service rendered Ë in another fashion, please specify OR b) If a Servicemark, check how the mark is used (check as many as apply). Mark is displayed: Ë in advertisements of the service Ë on documents, wrappers or articles delivered in connection with the service rendered Ë in another fashion, please specify 9. Date of the first use of mark by applicant or predecessor. Mark must be used in Illinois prior to registration. (If first use of mark was in Illinois, use same date in both A and B.) a) Anywhere b) In Illinois
Month, Day, Year Month, Day, Year
10. If either of the above first uses was by a predecessor of the applicant, state which use or uses were by a predecessor and identify predecessor
The applicant hereby appoints the Secretary of State of Illinois as agent for service of process in an action relating only to the registration, which may be issued pursuant to this application, if the renewal registrant be, or shall become, a non-resident individual, or foreign partnership, limited liability company, association, or corporation not licensed to do business in the State, or cannot be found in this State. The undersigned hereby declares, under penalty of perjury, that the statements made in the foregoing application are true, and that to his/her knowledge no other person has registered the mark, either federally or in this State, or has the right to use the mark either in the identical form thereof or in such near resemblance thereto as to be likely, when applied to the goods or services of such other person, to cause confusion or to cause mistake, or to deceive.
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Signature of Applicant Type or Print Name of Applicant
Official Capacity
Contact Phone Number
The following general classes of goods and services are established for convenience of administration of this Act, not to limit or extend the applicant’s or registrant’s rights. A single application for registration of a mark may include any or all goods or services upon which the mark is actually being used and which are comprised in a single class. In no event shall a single application include goods or services upon which the mark is being used and which fall within different classes. Classification of Goods for Trademarks 1 Chemicals 12 2 Paints 13 3 Cosmetics and cleaning preparations 14 4 Lubricants and fuels 15 5 Pharmaceuticals 16 6 Metal goods 17 7 Machinery 18 8 Hand tools 19 9 Electrical and scientific apparatus 20 10 Medical apparatus 21 11 Environmental control apparatus 22
Vehicles Firearms Jewelry Musical instruments Paper goods and printed matter Rubber goods Leather goods Non-metallic building materials Furniture and articles not otherwise classified Housewares and glass Cordage and fibers
23 24 25 26 27 28 29 30 31 32 33 34
Yarns and threads Fabrics Clothing Fancy goods Floor coverings Toys and sporting goods Meals and processed foods Staple foods Natural agricultural products Light beverages Wine and spirits Smoker’s articles
Classification of Services for Servicemarks 35 Advertising and business 39 Transportation and storage 36 Insurance and financial 40 Treatment of materials 37 Building construction and repair 41 Education and entertainment 38 Telecommunications 42 Scientific technological or legal
Printed by authority of the State of Illinois. May 2005 — 2M — C 246.5
43 Restaurants, hotels, motels and boarding 44 Medical, veterinary, beauty care and forestry 45 Personal, social and security