Mark Registration Form - Nevada Secretary Of State Page 2
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3BARBARA K. CEGAVSKE
Secretary of State
555 East Washington Ave., #5200
Las Vegas, Nevada 89101
(702) 486-2880
Website:
Mark Registration Form
(PURSUANT TO NRS 600)
Page 2
Important: Read attached instructions before completing form.
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
Date the mark was first used by applicant anywhere (display as mm/dd/yyyy):
9. Original Mark Date:
State the specific goods or services for which the mark will be used:
10. Use of Mark or
Name:
Check how trademark is used. By applying it:
directly to the goods,
directly to the containers for the
10a. Trademark:
goods,
to tags or labels affixed to the goods,
to tags or labels affixed to the containers for the goods.
(complete only if
By displaying it:
in physical association with the goods in the sale or distribution thereof,
trademark)
in advertising.
OR
Check how service mark is used. By displaying it:
in advertisements of the service,
on documents,
wrappers, or articles delivered in connection with the service rendered,
in other fashion; if so, please
10b. Service Mark:
specify:
(complete only if
service mark)
OR
State how trade name is used (ie. business card, letterhead, signage, etc.):
10c. Trade Name:
(complete only if
trade name)
The applicant herein states that he has read the above application and that the statement and facts set out therein are true that
the mark is currently in use by the applicant; that to the best of his knowledge and belief the applicant is the owner of the mark
sought to be registered and no other person has the right in the State of Nevada to use such mark either in the identical form
set forth in the application or in such near resemblance to it as might, when applied to the goods or services of such other
person, cause confusion or cause mistake or be calculated to deceive.
11. Notarized
Signature of
State of
Applicant:
X
County of
Signature of Applicant
This instrument was acknowledged before me on
,
Date
by
.
Printed Name of Applicant Signing
Notary Signature
Notary Stamp
Nevada Secretary of State Mark Registration Pg2
This form must be accompanied by appropriate fees.
Revised: 1-5-15
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