Trademark Or Service Mark Application - Nebraska Secretary Of State
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1
2TRADEMARK or SERVICE MARK APPLICATION
John A. Gale, Secretary of State
Room 1305 State Capitol, P.O. Box 94608
Lincoln, NE 68509
(402) 471-4079
Submit in Duplicate
T h e M a r k t o b e r e g i s t e r e d c o n s i s t s o f : ( d e s c r i p t i o n )
Applicant: ____________________________________________________________________
Address_______________________________________________________________________
street address
city
state
zip
Applicant is a: ___Corporation ___Limited Liability Company ___Limited Liability Partnership
___Limited Partnership ___Partnership ___Sole Proprietorship ___Other (specify)_________________
__
If other than a sole proprietorship give the state under whose laws the entity was formed________________
(a) If a trademark, check how the mark is used. By applying it: ___directly to goods, ___directly to the containers
for goods, ___to tags or labels affixed to the goods, ___to tags or labels affixed to containers for the goods
(b) If a service mark, check how the service mark is used. By applying it: ___in advertisements of the service,
____on documents, wrappers or articles delivered in connection with the service rendered, ___other (specify):
___________________________________________________
Classification Number _____________ (ONLY ONE, see page 2 of this document)
Date of first use of the mark by applicant: a. Anywhere _______________ b. in Nebraska _____________
State of ____________________
County of __________________
The applicant does hereby state and affirm that the applicant is the owner of the mark, the mark is in use, to the
applicant's knowledge no other person has registered, either federally or in this state, or has the right to use such mark
either in identical form or in such a near resemblance when applied to the good or services of such other person as to
cause confusion, mistake, or to deceive.
_____________________________
_________________________________
Signature of Applicant
Official Capacity of Applicant
Subscribed and sworn to before me this _______ day of ____________________, 20_____
seal
____________________________________
Notary Public
Please Note: Registration of a trademark or service mark with the State of Nebraska does not guarantee that a similar
mark has not been registered nationally with the U.S. Patent and Trademark Office. To check national availability
please call: 800-786-9199 or go to:
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