PDF document
- 1 -

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



- 2 -

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






PDF file checksum: 725499502

(Plugin #1/9.12/13.0)