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OFFICE OF SECRETARY OF STATE
CORPORATIONS DIVISION
2 Martin Luther King Jr. Dr. SE
Suite 313 West Tower
Atlanta, Georgia 30334
(404) 656-2817
http://sos.ga.gov/
Secretary of State
ASSIGNMENT FORM
TRADEMARK OR SERVICE MARK FILING EE F :$15.00
IN COMPLIANCE WITH THE REQUIREMENTS OFO.C.G.A.ยง10-1-446, THE UNDERSIGNED , HAVING ADOPTED AND USED A TRADEMARK
OR SERVICE MARK IN THIS STATE FOR PURPOSES PROVIDED IN THAT CODE CHAPTER ,DOES HEREBY CERTIFY THE FOLLOWING :
1. ____________________________________________________________________________________________________
ASSIGNOR (CURRENT REGISTERED WNERO )
2. ____________________________________________________________________________________________________
PRINCIPAL BUSINESS DDRESSA
3. ____________________________________________________________________________________________________
ASSIGNEE (NEW OWNER )
IF AN ENTITY ,ENTER STATE OR COUNTRY OF FORMATION :____________________________________
4. ____________________________________________________________________________________________________
PRINCIPAL BUSINESS DDRESSA
________________________________________________ ________________________________________________
PRIMARY EMAIL ADDRESS SECONDARY EMAIL ADDRESS
5. ____________________________________________________________________________________________________
MARK NAME
A. ______________________________________
REGISTRATION NUMBER
B. ______________________________________
INITIAL REGISTRATION ATED
C. ______________________________________
EXPIRATION DATE
BE IT KNOWN FOR AND IN CONSIDERATION OF MONIES ,AND/OR OTHER GOOD AND VALUABLE CONSIDERATION TO IT IN HAND PAID ,
THE RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED ,SAID ASSIGNOR DOES HEREBY SELL AND, OR/ ASSIGN AND, OR/TRANSFER UNTO
SAID ASSIGNEE THE ENTIRE RIGHT TITLE, AND INTEREST IN AND TO THE SAID MARK AND REGISTRATION THEREOF TOGETHER,WITH
THE GOOD WILL OF THE BUSINESS IN WHICH THE MARK IS USED OR WITH THAT PART OF THE GOOD WILL OF THE BUSINESS
CONNECTED WITH THE USE OF AND SYMBOLIZED BY THE MARK.
SIGNATURE OF ASSIGNOR /OWNER: ____________________________________________________
PRINT OR TYPE NAME: ____________________________________________________
TITLE (IF SIGNING FOR ENTITY): ____________________________________________________
EMAIL: ____________________________________________________
Return this completed form and a $15.00 filing fee to the Secretary of State at the above address before the expiration date. Fees are
non-refundable and non-transferable.
FORM TM03
(Rev. 6/2019)
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