Mark Disclaimer {MARK-1A}

STATE OF MAINE MARK DISCLAIMER (To be filed with registration)A. I hereby disclaim the exclusive right to (describe portion of text or feature disclaimed): _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ In regards to the registration of: B. 1. TEXT - list word(s) to be protected, if any (if none, so indicate): _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 2. FEATURES - describe in detail the design to be protected, if any (if none, so indicate): _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ NOTE: Text and Features must be stated as appears on registration form.C. TYPE OF MARK: ("X" one box only) ! Trademark - a mark applied to goods applicant manufactures or sells. ! Service Mark - a mark used in connection with services applicant provides. ! Combined Service/Trademark - a mark applied to goods and used in connection with services provided by the applicant. ! Certification Mark - a mark used by an organization to certify the characteristics of goods or services provided by others. ! Collective Mark - a mark used by members of a collective organization in connection with goods or services to indicate membership. <<<<<<<<<********>>>>>>>>>>>>> 2 D. I understand that I may not prevent another from using the disclaimed portion of this mark except as it might directly infringe on my rights as holder of this registered mark. Dated: _______________________ ____________________________________________________ (applicants signature) **************************************************************************************************************** State of ______________ County of ______________________ ____________________________________________________ (print/type applicants name) personally appeared and acknowledged the foregoing instrument by him/her subscribed to be his/her free act and deed. ____________________________________________________ Notary Public Dated: _______________________ SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101FORM NO. MARK-1A Rev. 4/16/2001 TEL. (207) 624-7740