Assignment Of Mark Form - Arizona Secretary Of State
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1Office Use_____________
Approved by:_____________
Please mail registration to:
Betsey Bayless
Secretary of State
Trademark Division
1700 West Washington 7th Floor
Phoenix, Arizona 85007
602/542-6187
Filing Fee: $15.00
ASSIGNMENT OF MARK
Be it known for good and valuable consideration in hand paid, the receipt of which is hereby
acknowledged, the entire right, title and interest in and to the mark:
Registration Number
on file in the Office of the Secretary of State of the State of Arizona, together with the good will of the
business in connection with which the said trademark is used.
Assignor:
Must be Trademark owner on file.
Business
Address:______________________________________________________________________________
Street or Box Number
City
State
Zip
Phone (Optional):
by these present does sell, assign and transfer unto:
Assignee:
Business Address:
Street or Box Number
City
State
Zip
Mailing Address:
Street or Box Number
City
State
Zip
Phone (Optional):
Do not check Corporation if you are not currently registered as a corporation, or your application
will be returned to you.
Individual
Partnership
Corporation
Foreign Corporation licensed for business in
Arizona.
_____________________
Date
Assignor’s Printed Name
Assignor’s Signature
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