Assignment Of Registration Of A Trademark Or Service Mark, Certification Mark, Or Collective Mark - Minnesota Secretary Of State
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1Minnesota Secretary of State
ASSIGNMENT OF REGISTRATION OF
A TRADEMARK OR SERVICE MARK,
CERTIFICATION MARK, OR
COLLECTIVE MARK
Fee: $15.00
File Number: ___________________________
Class: _________________________
MARK AS DESCRIBED ON CERTIFICATE: ______________________________________________________________________
___________________________________________________________________________________________________________
Name of Present Registrant:
___________________________________________________________________________________________________________
Address: ___________________________________________________________________________________________________
Street
City
State
Zip
The present registrant has filed this mark and is assigning this registration and all rights to and interest in this mark, including any
good will connected to the mark for valid consideration which has been received.
This mark is assigned to:
Name: _____________________________________________________________________________________________________
Address: ___________________________________________________________________________________________________
Street
City
State
Zip
State of Formation, if an entity: ______________________________________
I certify that I am authorized to execute this assignment and I further certify that I understand that by signing this assignment, I
am subject to the penalties of perjury as set forth in section 609.48 as if I had signed this assignment under oath.
_____________________________________________
_____________________________________________
Signature (on behalf of present registrant
(Print name and title)
Name and telephone number of contact person: ____________________________________________ (
) ________________
Please print legibly
Return this form and the $15.00 filing fee to:
Secretary of State
Business Services Section
180 State Office Bldg., 100 Constitution Ave.
St. Paul, MN 55155-1299, (651)296-2803
All of the information on this form is public and required in order to process this filing. Failure to provide the requested information
will prevent the Office from approving or further processing this filing.
This document can be made available in alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/
Voice. For TTY communication, contact Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803.
The Secretary of State’s Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin,
age, marital status, disability, religion, reliance on public assistance, or political opinions or affiliations in employment or the
provision of services.
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Separate assignment required for each class.
08930919 Rev. 06/01
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