HTML Preview Recordation Form for Trademarks USA page number 1.
RECORDATION FORM COVER SHEET
TRADEMARKS ONLY
Form PTO-1594 (Rev. 12-11)
O
MB Collection 0651-0027 (exp. 04/30/2015)
U.S. DEPARTMENT OF COMMERCE
United States Patent and Trademark Office
To the Director of the U. S. Patent and Trademark Office: Please record the attached documents or the new address(es) below.
1. Name of conveying party(ies): 2. Name and address of receiving party(ies)
Name
:
__
______________________________________
Street
Address:
______________________________
3. Nature of conveyance/Execution Date(s) :
Assignment
Security Agreement
Other
_____________________________________
Merger
Change of Name
Countr
y:
_
____________________
Zip
:
__
_____________
If assignee is not domiciled in the United States, a domestic
representative designation is attached:
Additional names, addresses, or citizenship attached?
Association
Partnership
Limited Partnership
Corporation Citizenship____________________________
Yes No
Yes
No
Other____________
4. Application number(s) or registration number(s) and identification or description of the Trademark.
A. Trademark Application No.(s)
B. Trademark Registration No.(s)
Additional sheet(s) attached?
Yes No
5. Name & address of party to whom correspondence
concerning document should be mailed:
6. Total number of applications and
registrations involved:
7. Total fee (37 CFR 2.6(b)(6) & 3.41)
$____________
Enclosed
Name:
________________________________________
Internal Address: ________________________________
9. Signature:
Total number of pages including cover
sheet, attachments, and document:
DateSignature
Name of Person Signing
Documents to be recorded (including cover sheet) should be faxed to (571) 273-0140, or mailed to:
M
ail Stop Assignment Recordation Branch, Director of the USPTO, P.O. Box 1450, Alexandria, VA 22313-1450
State: ____________________
Zip:
________________
City:
__________________________________________
Individual(s)
Partnership
Corporation- State:
_________________________
Other
_________________________________
Association
Limited Partnership
Additional names of conveying parties attached?
Yes No
Citizenship (see guidelines)
_______________________
Phone Number: _________________________________
Ema
il Address: _________________________________
Autho
rized to be charged to deposit account
8. Payment Information:
Deposit Account Number _____________________
Citizenship
__________________________
Citizenship
____________________
Citizenship
____________________
Citizenship ___________________
City:
_________________________________________
Street
Address:
C. Identification or Description of Trademark(s) (and Filing Date if Application or Registration Number is unknown):
Authorized User Name
_______________________
State: ________________________________________
(Designations must be a separate document from assignment)
Docket Number:
_________________________________
Execution Date(s) _______________________________
Text
Individual(s)
Citizenship
__________________________