Enlarge image | PAUL D. PATE Secretary of State Assignment of State of Iowa Registration of Mark 1 2 Whereas ___________________________________ of __________________________________ in the City of 3 4 _______________________________State of _________________________ , has adopted, used, and is using the 5 mark which is registered with the Secretary of State under Registration No _____________________, a copy of 6 which is attached hereto, dated the ________ day of__________________ , _______ and, 7 8 Whereas ___________________________________ of __________________________________ , in the City 9 10 of ______________________________State of _________________________ , is desirous of acquiring said mark and registration thereof. Now, therefore, for good and valuable consideration, receipt of which is hereby acknowledged, 1 7 said _______________________________ does hereby assign unto __________________________all right, title, and interest in and to said mark, together with the good will of the business in which the mark is used (or that part of the good will of the business connected with the use of and symbolized by the mark) and the 5 Registration No ________________________thereof. Assignor By: _________________________________________________ _________________________________________________ Printed Name _________________________________________________ Date 635_0001 10/21 |
Enlarge image | PAUL D. PATE INSTRUCTIONS for Secretary of State Assignment of State of Iowa Registration of Mark IT IS IMPORTANT that you read and understand these instructions before you begin to complete the assignment form. Failure to complete the form correctly or to provide all the requested information will result in the submission being returned. If you have any questions, contact the secretary of state's office at (515) 281-5204. 1. All items must be completed before the assignment can be filed. Other documents or materials may be attached to the application. In such cases, the material or documents should be referenced in the form and clearly marked for ease of identification. ITEM 1 Insert the name of the party in whose name the trademark registration is currently held, which desires to assign the trademark registration and the mark's associated good will to a different party (theassignor). ITEM 2 Insert the street address of the party identified in #1. ITEM 3 Insert the city name for the address in #2. ITEM 4 Insert the name of the state in which the city identified in #3 is located. ITEM 5 Insert the trademark registration number found in the upper left corner of the trademark certificate of registration under the heading "secretary of state." Example:5480TM-000128114. ITEM 6 Insert the date the trademark certificate was issued; located on the trademark certificate of registration. ITEM 7 Insert the name of the party to whom the trademark will be assigned (the assignee). ITEM 8 Insert the street address of the party identified in #7. ITEM 9 Insert the city name for the address in #8. ITEM 10 Insert the name of the state in which the city in #9 is located. 2. A copy of the certificate of registration must be attached to this form. If you do not have a copy, one may be obtained by calling515-281-5204. 3. The form must be signed by the person in whose name the trademark certificate of registration is issued or the duly appointed representative of the person. NOTES: 1. The filing fee is $5.00. Make checks payable to: SECRETARY OF STATE 2. The information you provide will be open to public inspection under Iowa Code chapter 22.11. SECRETARY OF STATE Business Services Division Lucas Building, 1st Floor Des Moines, IA 50319 Phone:(515)281-5204 FAX: (515) 242-5953 Website: www.sos.iowa.gov |