Form Tm 2 - Application For Renewal Of Registration Of A Trademark Or Service Mark (Page 2 of 2) in pdf

TM 2 (11/09)

COMMONWEALTH OF VIRGINIA

STATE CORPORATION COMMISSION

DIVISION OF SECURITIES AND RETAIL FRANCHISING

APPLICATION FOR RENEWAL OF REGISTRATION OF A TRADEMARK

OR SERVICE MARK

(Please type or print)

Applicant (owner) name and address:____________________________________________________________________

__________________________________________________________________________________________________

Contact person name and address:_______________________________________________________________________

___________________________________Daytime phone:__________________Fax number:______________________

Applicant is a:_______________________________Applicant's state or jurisdiction of formation: ___________________

(entity type i.e. corporation, partnership, etc)

On the ___________ day of _________________________, ______, the mark identified below was registered in the

name of:___________________________________________________________________________________________

Identify the trademark or service mark (or attach an exhibit of the exact mark):

__________________________________________________________________________________________________

Class number(s) of goods or services:____________________________________________________________________

Describe the product(s) or service(s) the mark represents (identifies):___________________________________________

__________________________________________________________________________________________________

PLEASE NOTE: A specimen of the mark must accompany this application.

If the applicant is not the registrant named above, the applicant is the assignee to whom a new certificate was

issued on the _____________ day of ________________________________, _____.

The applicant asserts that it is the owner of this mark and that the mark has been and is still in use in the

Commonwealth of Virginia. No other person has the right to use this mark in Virginia, either in the identical form thereof

or in such near resemblance thereto as to be likely, when applied to the goods or services of such person, to cause confusion

or mistake, or to deceive.

(NOTE: The application must be signed in the name of the applicant, either by the applicant or by a person authorized by

the applicant. The application must be sworn to by the person who signed the name of the applicant.)

Signature:________________________________________________________Date:_____________________________

Signer’s Name:____________________________________________________Title:_____________________________

(print or type)

State of:__________________________________, County/City of:______________________________________, to-wit:

The foregoing application was subscribed and sworn to before me by: __________________________________________

on the____________________________day of____________________________, ____.

My Commission Expires:______________________________ Notary Public:___________________________________

Form Tm 2 - Application For Renewal Of Registration Of A Trademark Or Service Mark Page 2