PDF document
- 1 -

Enlarge image
                     PAUL D. PATE

           Secretary of State                     Assignment of

                              State of Iowa      Registration of Mark

  STATE OF_____________________________ )
                               ) SS
  COUNTY OF___________________________ )

        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.

                                           By: ___________________________________________________
                                                      Assignor

        Subscribed and Sworn to before me this _______________day of________________________ 19 _____.

                                           ______________________________________________________
                                                   Notary Public

635_0001
  1/15



- 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 assignment 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 will be considered. Other documents or materials may be attached to
   the application. In such cases, the material or documents should be referenced to the form and clearly marked for ease of
   identification.

   ITEM 1  Insert the name of the party in whose name the trademark certificate is now held, who desires to assign the trade mark
           (the assignor).

   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 underthe heading
           "secretary of state." Example: 5480TM-000128114.

   ITEM 6  Insert the date the trademark certificate was issued; located on the trademark certificate.

   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 trademark certificate must be attached to the assignment. If you do not have a copy, one may be obtained
   by calling 515-281-5204.

3. The assignment must be signed by the person in whose name the trademark certificate is issued or the duly appointed
   representative of the person, and must be notarized.

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: 1698285356

(Plugin #1/8.13/12.0)