Recordation Form Cover Sheet Trademarks Only {PTO 1594}

Form PTO-1594 (Rev. 6-12) OMB Collection 0651-0027 (exp. 04/30/2018) U.S. DEPARTMENT OF COMMERCE United States Patent and Trademark Office RECORDATION FORM COVER SHEET TRADEMARKS ONLY 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) Additional names, addresses, or citizenship attached? Yes No Name: ________________________________________ Individual(s) Partnership Association Limited Partnership Street Address: ______________________________ City: State: _________________________________________ ________________________________________ Corporation- State:_________________________ Other_________________________________ Citizenship (see guidelines) _______________________ Additional names of conveying parties attached? Yes No Country:_____________________Zip: _______________ Individual(s) Citizenship Association Partnership Citizenship Citizenship __________________________ __________________________ ____________________ 3. Nature of conveyance/Execution Date(s) : Execution Date(s)_______________________________ Assignment Security Agreement Merger Limited Partnership Citizenship ____________________ Corporation Citizenship____________________________ Other____________ Citizenship ___________________ If assignee is not domiciled in the United States, a domestic Yes No representative designation is attached: (Designations must be a separate document from assignment) Change of Name Other_____________________________________ 4. Application number(s) or registration number(s) and identification or description of the Trademark. Text B. Trademark Registration No.(s) A. Trademark Application No.(s) Additional sheet(s) attached? Yes No C. Identification or Description of Trademark(s) (and Filing Date if Application or Registration Number is unknown): 5. Name & address of party to whom correspondence concerning document should be mailed: Name:________________________________________ Internal Address:________________________________ Street Address: City:__________________________________________ State:____________________ Zip:________________ Phone Number: _________________________________ Docket Number: _________________________________ Email Address:_________________________________ 9. Signature: Signature Name of Person Signing 6. Total number of applications and registrations involved: 7. Total fee (37 CFR 2.6(b)(6) & 3.41) $____________ Authorized to be charged to deposit account Enclosed 8. Payment Information: Deposit Account Number _____________________ Authorized User Name _______________________ Date Total number of pages including cover sheet, attachments, and document: Documents to be recorded (including cover sheet) should be faxed to (571) 273-0140, or mailed to: Mail Stop Assignment Recordation Branch, Director of the USPTO, P.O. Box 1450, Alexandria, VA 22313-1450 American LegalNet, Inc. www.FormsWorkFlow.com Guidelines for Completing Trademarks Cover Sheets (PTO-1594) Cover Sheet information must be submitted with each document to be recorded. If the document to be recorded concerns both patents and trademarks, separate patent and trademark cover sheets, including any attached pages for continuing information, must accompany the document. All pages of the cover sheet should be numbered consecutively for example, if both a patent and trademark cover sheet is used, and information is continued on one additional page for both patents and trademarks, the pages of the cover sheet would be numbered from 1 to 4. Item 1. Name of Conveying Party(ies). Enter the full name of the party(ies) conveying the interest. If there is more than one conveying party, enter a check mark in the "Yes" box to indicate that additional information is attached. The name of the second and any subsequent conveying party(ies) should be placed on an attached page clearly identified as a continuation of the information in Item 1. Enter a check mark in the "No" box, if no information is contained on an attached page. Item 2. Name, Address, Legal Entity Type, and Citizenship of Assignee. Enter the name and complete address of the first party receiving the interest. If there is more than one receiving party,check the "Yes" box to indicate that additional information is attached and write the wording "See additional sheet" on the citizenship line. On a separate sheet, provide all of the necessary information about the other receiving parties, as explained below. If the receiving party is an individual, check the "Individual" box and enter the citizenship of the receiving individual. If the receiving party is a legal entity, i.e., corporation, association, limited partnership, etc., designate the legal entity and citizenship of the receiving party by checking the appropriate box and filling in the citizenship information. If a box is not provided for the legal entity, check the "Other" box and write the nature of the legal entity, e.g., limited liability company, trust, estate, etc., and its citizenship. Information about the entity type and citizenship is mandatory. The citizenship of a legal entity is as follows: for a corporation, it is the U.S. state (or foreign country) of incorporation; for an association, it is the U.S. state (or foreign country) under which it is organized; for a partnership or joint venture, it is the U.S. state (or foreign country) under which it is organized, etc. In addition, for a domestic partnership or domestic joint venture, the cover sheet must include the names, legal entities, and national citizenship (or the state or country of organization) of all general partners or active members that compose the domestic partnership or domestic joint venture. For a trust or estate, the same information should be provided. If additional space is needed, check the "Yes" box to indicate that additional information is attached, write the wording "See additional sheet" next to the appropriate entity designation, and provide the required information on the additional sheet. If the receiving party is not domiciled in the United States, a designation of domestic representative is encouraged. Check the appropriate box to indicate whether or not a designation of domestic representative is attached. Check the "No" box if no information is attached. Item 3. Nature of Conveyance/Execution Date(s). Enter the execution date(s) of the document. It is p