Form PTO-1594 Trademark Recordation Form Cover Sheet

Doc Code:

Form PTO-1594 (Rev. 07/05)
OMB Collection 0651-0027 (exp. 6/30/2008)

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

Individual(s)

Association

Name:________________________________________
Internal
Address:______________________________________

General Partnership

Limited Partnership

Street Address:______________________________

Corporation- State:_________________________
Other _________________________________
Citizenship (see guidelines)_______________________
Additional names of conveying parties attached?

Yes

No

3. Nature of conveyance )/Execution Date(s) :
Execution Date(s)_______________________________
Assignment

Merger

Security Agreement

Change of Name

Other_____________________________________

City:____________________________________________________
State:________________________________________
Country:_____________________Zip:______________
Association

Citizenship _________________________

General Partnership

Citizenship ____________________

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)

4. Application number(s) or registration number(s) and identification or description of the Trademark.
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 6. Total number of applications and
concerning document should be mailed:
registrations involved:
Name:________________________________________
Internal Address:________________________________

7. Total fee (37 CFR 2.6(b)(6) & 3.41)

$_____________

Authorized to be charged by credit card
Authorized to be charged to deposit account

Street Address:

Enclosed

City:__________________________________________
State:____________________

Zip:________________

Phone Number: _________________________________
Fax Number: ___________________________________
Email Address: _________________________________

8. Payment Information:
a. Credit Card

Last 4 Numbers ________________
Expiration Date ________________

b. Deposit Account Number _____________________
Authorized User Name _______________________

9. Signature:
Signature
Name of Person Signing

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 Services, Director of the USPTO, P.O. Box 1450, Alexandria, VA 22313-1450

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 and Address of Receiving Party(ies).
Enter the name and full address of the first party receiving the interest. If there is more than one party receiving the
interest, enter a check mark in the “Yes” box to indicate that additional information is attached. If the receiving party is an
individual, check the “other” box, place the word “individual” in the following line, and enter the citizenship of the receiving
individual. If the receiving party is a legal entity, designate the legal entity of the receiving party by checking the appropriate
box. If the receiving party has more than one citizenship, then the citizenship of each partner should be specified on an
additional sheet, and “See additional sheet” should be written on the line for citizenship. A corporation must set forth the
state, if applicable, or country of incorporation. An association must set forth the state, if applicable, or country under which
they are organized. If the receiving party is not domiciled in the United States, a designation of domestic representative is
encouraged. Place a check mark in the appropriate box to indicate whether or not a designation of domestic representative
is attached. Enter a check mark in the “No” box if no information is contained on an attached page.
Item 3. Nature of Conveyance/Execution Date(s).
Enter the execution date(s) of the document. It is preferable to use the name of the month, or an abbreviation of that
name, to minimize confusion over dates. In addition, place a check mark in the appropriate box describing the nature of the
conveying document. If the “Other” box is checked, specify the nature of the conveyance. The "Other" box should be
checked if the conveying/receiving party is correcting a previously filed document.
Item 4. Application Number(s) or Registration Number(s).
Indicate the application number(s) including series code and serial number, and/or registration number(s) against
which the document is to be recorded. The identification of the trademark should be provided for all properties to avoid
recordation against the wrong property. A filing date should be provided only when the application or registration number is
unknown. Enter a check mark in the appropriate box: “Yes” or “No” if additional numbers appear on attached pages. Be
sure to identify numbers included on attached pages as the continuation of Item 4.
Item 5. Name and Address of Party to whom correspondence concerning document should be mailed.
Enter the name and full address of the party to whom correspondence is to be mailed.
Item 6. Total Applications and Trademarks Involved.
Enter the total number of applications and trademarks identified for recordation. Be sure to include all applications
and registrations identified on the cover sheet and on additional pages.
Block 7. Total Fee Enclosed.
Enter the total fee enclosed or authorized to be charged. A fee is required for each application and registration
against which the document is recorded.
Item 8. Payment Information.
Enter either the last four digits of your credit card and expiration date or the deposit account number and authorized
user name to authorize charges.
Item 9. Signature.
Enter the name of the person submitting the document. The submitter must sign and date the cover sheet. Enter the
total number of pages including the cover sheet, attachments, and document.
This collection of information is required by 35 USC 261 and 262 and 15 USC 1057 and 1060. The information is used by the public to submit (and by the
USPTO to process) patent and trademark assignment requests. After the USPTO records the information, the records for patent and trademarks, assignments,
and other associated documents can be inspected by the public. To view documents recorded under secrecy orders or documents recorded due to the interest
of the federal government, a written authorization must be submitted. This collection is estimated to take 30 minutes to complete, including gathering,
preparing, and submitting the form to the USPTO. Any comments on the amount of time you require to complete this form and/or suggestions for reducing
this burden, should be sent to the Manager of the Assignment Division, Crystal Gateway 4, Room 310, 1213 Jefferson Davis Highway, Arlington, VA
22202. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Mail Stop Assignment Recordation Services, Director of the
USPTO, P.O. Box 1450, Alexandria, VA 22313-1450.