The
Attorney Information page will automatically
display within this form
for editing or removing the attorney information appearing
above.
Power
of Attorney: The USPTO
considers the power of attorney to end: (1) upon the date of
registration; or (2) the final acceptance or denial of a
required post-registration filing. Filing this form will
automatically update the Attorney of Record and the Primary
Email Address for Correspondence in the USPTO's Trademark
Status & Document Retrieval (TSDR) database.
It is not necessary to file a separate appointment
form.
Foreign-domiciled
owners/holders must
have a U.S.-licensed attorney represent
them before the USPTO in any application-or
registration-related filing. Information
about hiring a U.S.-licensed attorney can
be found on the USPTO website.
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Owner
Information
Instructions:
Update
the mailing address, if needed.
The address entered on this page is publicly viewable in the
USPTO's TSDR database
and is presumed to be the owner's/holder's domicile.
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* Owner
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Check
this box only if the owner listed above does not identify the
current trademark owner. The trademark owner is the legally
recognized entity or individual that owns the trademark.
If
there has been a change in ownership or legal name of the owner,
you must enter the new owner in this form. Instructions will be
provided when you check the box. For more information, see
our webpage
on modifying owner information in online forms.
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DBA (doing
business as)
AKA
(also known as)
TA
(trading as)
Formerly
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Legal
Entity Type: Corporation
Citizenship/State, Country,
Region, or Jurisdiction Where Organized: Indiana
Check
this box only if no information is listed in the field/s or if the
information listed is not correct for the current owner of the
trademark.
Instructions will be provided when you check
the box.
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Internal
Address
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* Mailing
Address
(Entered
address is publicly viewable in the USPTO's
TSDR database.
This address must be capable of receiving mail and may be your
street address, a P.O. box, or a "care of" address.)
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NOTE: You
must limit your entry here, and for all remaining fields within
this overall section, to no more than 40 characters (the storage
limit for the USPTO database). You may need to abbreviate some
words, e.g., St. instead of Street. Failure to do so may result in
an undeliverable address, due to truncation at the 40 character
limit.
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* City
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NOTE: You
must limit your entry here to no more than 22 characters.
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* State
(Required
for U.S. owners/holders only)
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NOTE: You
must include as part of the "City" entry any information
related to geographical regions (e.g., provinces) not found in the
dropdown lists for "States" or "Countries."
Enter the city and then the geographical region, separated by a
comma (e.g., Toronto, Ontario). In most instances, you will then
also have to select the country within which the region is found,
below.
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* Country/Region/Jurisdiction/U.S.
Territory
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* Zip/Postal
Code
(Required
for U.S. and certain international addresses)
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Domicile
Address
(Entered
address is not publicly viewable in the USPTO's TSDR database
unless it is the same as the mailing address. If your mailing
address is not your domicile, you must enter the number, street,
city, state, country or U.S. territory, and if applicable,
zip/postal code of your domicile address.
In most cases, a P.O. box, "care of" address, or similar
variation is not acceptable as a domicile address.)
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Uncheck
this box if the Domicile Address and mailing address of the
applicant owner/holder are NOT the same.
Indicate
place you reside and intend to be your principal home (for
individual) or your principal place of business (for entity).
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Phone
Number
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Fax
Number
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* Email
Address
Confirm
that the email address is correct before continuing. The owner
email address is not publicly viewable in the
USPTO's TSDR database.
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The
owner/holder is required to provide an email address and keep that
address current with the USPTO. If the owner/holder is represented
by a U.S.-licensed attorney, only the attorney's email address
will be used for correspondence by the USPTO.
NOTE:
The owner/holder or the owner's/holder's attorney acknowledges
that he or she is solely responsible for receiving USPTO emails.
Additionally, the owner/holder or the owner's/holder's attorney is
responsible for periodically checking the status of the
application/registration using the Trademark
Status & Document Retrieval (TSDR) system.
USPTO notices and office actions issued in this
application/registration can be viewed online using TSDR.
The USPTO is not responsible for any failure to receive a
USPTO-issued email due to the receiver's security or anti-spam
software, or any problems with the receiver's email system
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Goods/Services/Collective
Membership Information
WARNING: Registration
Subject to Cancellation for Fraudulent Statements
You
must ensure that statements made in filings to the USPTO are
accurate, as inaccuracies may result in the cancellation of a
trademark registration. The
lack of use on all goods/services, or to indicate
membership in the collective organization for which you claim use
in a post-registration filing with the USPTO could jeopardize the
validity of the registration and result in its cancellation.
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Enter
information for the Class
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* International
Class:
Current
listing of goods/services/nature of the collective membership
organization:
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For
a trademark or service mark application:
The owner/holder has continuously used the mark in commerce
for five (5) consecutive years after the date of registration,
or the date of publication under Section 12(c), and is still
using the mark in commerce on or in connection
with ALL goods/ALL services/to
indicate membership in the collective membership organization
listed in the existing registration for this class; For
a collective trademark, collective service mark, or collective
membership mark application:
the owner/holder has continuously exercised legitimate control
over the use of the mark in commerce by members on or in
connection with the identified goods/services/collective
membership organization for five (5) consecutive years after
the date of registration, or the date of publication under
Section 12(c), and is still exercising legitimate control over
the use of the mark in commerce by members on or in connection
with ALL goods/services, or to indicate membership in the
collective membership organization listed in the existing
registration for this class; For
a certification mark application:
the owner/holder has continuously exercised legitimate control
over the use of the mark in commerce by authorized users on or
in connection with the identified goods/services for five (5)
consecutive years after the date of registration, or the date
of publication under Section 12(c), and is still exercising
legitimate control over the use of the mark in commerce by
authorized users on or in connection with ALL goods/services
listed in the existing registration for this class. Also,
there has been no final decision adverse to the
owner's/holder's claim of ownership of such mark for those
goods/services, or to indicate membership in the collective
membership organization, or to the owner's/holder's right to
register the same or to keep the same on the register; and,
there is no proceeding involving said rights pending and not
disposed of in either the U.S. Patent and Trademark Office or
in a court.
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The
filing does not cover
this specific class.
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For
a trademark or service mark application:
The owner/holder has continuously used the mark in commerce for
five (5) consecutive years after the date of registration, or
the date of publication under Section 12(c), and is still using
the mark in commerce on or in connection
with ALL goods/services
listed in the existing registration for this class; For
a collective trademark, collective service mark, or collective
membership mark application:
the owner/holder has continuously exercised legitimate control
over the use of the mark in commerce by members on or in
connection with the identified goods/services for five (5)
consecutive years after the date of registration, or the date
of publication under Section 12(c), and is still exercising
legitimate control over the use of the mark in commerce by
members on or in connection with ALL goods/services listed in
the existing registration for this class; For
a certification mark application:
the owner/holder has continuously exercised legitimate control
over the use of the mark in commerce by authorized users on or
in connection with the identified goods/services for five (5)
consecutive years after the date of registration, or the date
of publication under Section 12(c), and is still exercising
legitimate control over the use of the mark in commerce by
authorized users on or in connection with ALL goods/services
listed in the existing registration for this class. Also, there
has been no final decision adverse to the owner's/holder's
claim of ownership of such mark for those goods/services or to
the owner's/holder's right to register the same or to keep the
same on the register; and, there is no proceeding involving
said rights pending and not disposed of in either the U.S.
Patent and Trademark Office or in a court.
THE
ABOVE STATEMENT IS ENTIRELY TRUE, EXCEPT FOR
THE GOODS/SERVICES LISTED BELOW. THIS FILING SPECIFICALLY
DOES NOT COVER
THE FOLLOWING GOODS/SERVICES:
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IN
THE FOLLOWING SPACE, PROPOSE HOW THE COMPLETE "FINAL"
LISTING SHOULD APPEAR, ONLY SPECIFY THOSE GOODS/SERVICES TO
WHICH THE SECTION 15 AFFIDAVIT/DECLARATION PERTAINS. ALTHOUGH
SOME GOODS/SERVICES MAY BE OMITTED FROM THE LISTING, NO OTHER
MODIFICATION OF ANY WORDING IN THE IDENTIFICATION IS
PERMITTED.
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Attorney
Information
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* Attorney
Name
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Firm
Name
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Docket/Reference
Number
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NOTE: You
must limit your entry here to no more than 12 characters.
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* Bar
Membership
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* Year
of Admission 
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* U.S.
State/Commonwealth/Territory 
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* Membership
Number
You
must enter "N/A" or a membership/registration number if
your U.S. state, commonwealth, or territory issues one. This
number is not viewable in TSDR.
You must limit your entry
here to no more than 40 alphanumeric characters.
* The
attorney of record is an active member in good standing of the bar
of the highest court of a U.S. state, the District of Columbia, or
any U.S. Commonwealth or territory.
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Other
Appointed Attorney(s)
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Recognized
Canadian
Attorney/Agent
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Internal
Address
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* Street
Address
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NOTE: You
must limit your entry here, and for all remaining fields within
this overall section (except City, see below),
to no more than 40 characters (the storage limit for the USPTO
database). You may need to abbreviate some words, e.g., St.
instead of Street. Failure to do so may result in an undeliverable
address, due to truncation at the 40 character limit.
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* City
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NOTE: You
must limit your entry here to no more than 22 characters.
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* State
(Required
for U.S. addresses)
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NOTE: You
must include as part of the "City" entry any information
related to geographical regions (e.g., provinces) not found in the
dropdown lists for "States" or "Countries."
Enter the city and then the geographical region, separated by a
comma (e.g., Toronto, Ontario). In most instances, you will then
also have to select the country within which the region is found,
below.
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* Country/Region/Jurisdiction/U.S.
Territory
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* Zip/Postal
Code
(Required
for U.S. and certain international addresses)
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Phone
Number
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Fax
Number
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* Email
Address
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The
appointed attorney's email address must be provided and kept
current with the USPTO.
NOTE:
The owner/holder or the owner's/holder's attorney acknowledges
that he or she is solely responsible for receiving USPTO emails.
Additionally, the owner/holder or the owner's/holder's attorney is
responsible for periodically checking the status of the
application/registration using the Trademark
Status & Document Retrieval (TSDR) system.
USPTO notices and office actions issued in this
application/registration can be viewed online using TSDR.
The USPTO is not responsible for any failure to receive a
USPTO-issued email due to the receiver's security or anti-spam
software, or any problems with the receiver's email system.
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Correspondence
Information
To
make changes to the Primary
Email Address for Correspondence below,
either
(1) return to the Owner Information section (if no
attorney has been appointed) and enter the change, or
(2) use
the Attorney Information section of the form to enter the change
(if an attorney has been appointed).
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Name
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Email
Address
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Primary
Email Address for Correspondence:
Secondary Email Address(es)
(Courtesy Copies) 
Enter
up to 4 addresses, separated by either a semicolon or
a comma.
Only
the Primary Email Address is used for official communication by
the USPTO. The owner/holder or the owner's/holder's appointed
attorney must keep this email address current. The owner/holder or
the owner's/holder's appointed attorney may provide Secondary
Email Addresses for receiving courtesy copies.
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Miscellaneous
Information
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To
attach your file, please note that:
*Click
on the 'Attach' button to select the file in JPG/PDF format (not
exceeding 5 megabytes per attachment for JPG or 30 megabytes per
attachment for PDF) or .WAV, .WMV, .WMA, .MP3, .MPG, or .AVI
format (not exceeding 5 megabytes for sound files or 30 megabytes
for motion files).
0file(s)
attached
Miscellaneous
Statement: Enter
information for which no other section of the form is appropriate.
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Section
15 Filing Fee: $200
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Number
of Classes
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Note: The
filing fee is computed based on the Number of Classes in
which the goods/services/collective membership organization
associated with the mark is/are classified.
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Section
15 Filing Fee
(Number of Classes x
$200 (per class))
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$
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Total
Fee Paid
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Amount
Section 15 Filing Fee
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$
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(required
only if completing the form for the first time)
(MM/DD/YYYY)
STEP
2: If any of the information
is incorrect, click on the Go Back to Modify button below to make
changes; then re-validate using the Validate button at the bottom
of the Declaration of Incontestability of a Mark under Section 15.
If there are no errors and you are ready to file electronically,
first use your print function within your browser to print each of
these pages for your own records. Then, click on the Pay/Submit
button below. This will bring up a screen for you to enter the
appropriate payment information. After successful entry of the
payment information, you will be able to complete the submission
to the USPTO.