Statement of Trademark Registration of a Non-Reporting Entity

Fee:

$30.00

Your document will be available to the public.

* Required field.

Such non-reporting entity is a general partnership

Yes No

If such non-reporting entity is a general partnership, provide the name of one general partner; otherwise, provide the true name of the non-reporting entity.

If an individual:

Last Name

First Name

Middle Name

Suffix

If an entity:

True name:

Form:

Form (If Other) selected above:

Jurisdiction:

Jurisdiction (If Other) selected above:

Street Address

Address 1:	*
Address 2:
City:	*
State:	*
Zip / Postal Code:	*
Province:
Country:

Mailing Address

Address 1:
Address 2:
City:
State:
Zip / Postal Code:
Province:
Country:

Such individual does not maintain a registered agent in this state and the mailing address to which service of process in any proceeding based on a cause of action with respect to the statement of trademark registration may be mailed pursuant to section 7-70-108, C.R.S. is

Address 1:
Address 2:
City:
State:
Zip/Postal Code:
Province:
Country:

---------- OR ----------

Such registrant maintains a registered agent in this state and such registered agent's name and address are

Registered Agent:

The person appointed as registered agent in the document has consented to being so appointed.

if agent is an individual...

Last Name *

First Name *

Middle Name

Suffix

if agent is a business organization...

Business Organization Name:

Street Address

Address 1:	*
Address 2:
City:	*
State:	CO
Zip:	*

Mailing Address (only enter a mailing address if it is different than the street address)

Address 1:
Address 2:
City:
State:	CO
Zip:

The trademark is a standard character trademark and the characters constituting the trademark are

The trademark is a special form trademark and a description of the attached drawing is

A detailed description of the goods or services in connection with which the trademark is used is:

The class into which such goods or services fall is:

A description of the attached specimen sufficient to identify the nature of the specimen is:

The date of first use in commerce of the trademark in this state by such registrant or such registrant's predecessor in interest is:

The registrant identified above is currently using the trademark in commerce in this state and such registrant believes, in good faith, that such registrant has the right to use the trademark in connection with the goods or services listed above and such registrant's use of the trademark does not infringe the rights of any other person in that trademark.

Attach Additional Information

Do you need to attach additional information?
	Yes, I need to add attachments. (You will upload files on the next page.) No.

Email Address

Our office can send you email notifications about due dates and other events affecting this business record. Information about email notifications.

Email address will not be sold or otherwise disclosed by our office, and your email address will not appear on your filed document.

	Do you want to sign up for email notifications?*
		Yes. Send my notifications to this email address:
		No. I don't want to sign up for email notifications.

Notice:

Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the individual's act and deed, or that the individual in good faith believes the document is the act and deed of the person on whose behalf the individual is causing the document to be delivered for filing, taken in conformity with the requirements of part 3 of article 90 of title 7, C.R.S., and, if applicable, the constituent documents, and the organic statutes, and that the individual in good faith believes the facts stated in the document are true and the document complies with the requirements of that Part, the constituent documents, and the organic statutes.

This perjury notice applies to each individual who causes this document to be delivered to the secretary of state, whether or not such individual is named in the document as one who has caused it to be delivered.

The true name and mailing address of the individual causing this document to be delivered for filing are

Last Name *

First Name *

Middle Name

Suffix

Address 1:	*
Address 2:
City:	*
State:	*
Zip/Postal Code:	*
Province:
Country:

(If 'Yes' is selected, include an attachment with the true name and mailing address of additional individuals.)
Additional individuals are causing this document to be delivered for filing.

Yes
No

Disclaimer:

This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, and are furnished without representation or warranty. While this form/cover sheet is believed to satisfy minimum legal requirements as of its revision date, compliance with applicable law, as the same may be amended from time to time, remains the responsibility of the user of this form/cover sheet. Questions should be addressed to the user's legal, business or tax advisor(s).

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