Form TM04 "Trademark or Service Mark Registrant Name and/Or Address Change" - Georgia (United States)

What Is Form TM04?

This is a legal form that was released by the Georgia Secretary of State - a government authority operating within Georgia (United States). As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 20, 2019;
  • The latest edition provided by the Georgia Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form TM04 by clicking the link below or browse more documents and templates provided by the Georgia Secretary of State.

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Download Form TM04 "Trademark or Service Mark Registrant Name and/Or Address Change" - Georgia (United States)

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INSTRUCTIONS (FORM TM04)
NOTE: This form (Form TM04) is only for changing the name and/or address of the registrant of a
registered trademark or service mark. This form may not be used to assign or transfer ownership of
a registered mark. Use the assignment form (Form TM03) to change the owner of a registered mark
from one person/entity to a different person/entity.
Line 1: Enter the trademark or service mark registration number.
Line 2: Enter the name of the mark as it appears on the records of the Secretary of State’s office.
Line 3: Enter the date of registration of the trademark or service mark.
Line 4. Enter the registrant’s name and business address as it currently appears on the records of the
Secretary of State’s office.
Line 5. Check and complete all that apply.
a. Registrant Name Change – Enter the new name of the registrant, and the effective date of
the name change. Submit supporting documentation showing the change of name of the
registrant.
b. Registrant Address Change – Enter the new business address of registrant, new
mailing address, and/or new secondary email address of the registrant.
Line 6. If registrant is an entity, enter the state or country of incorporation/formation/organization.
Line 7. Sign, date, print the signer’s name, and enter the title of the signer if applicable. Enter the
signer’s email address. Application must be signed by the registrant only. For a registrant that is
an individual, the application must be signed by that individual. For corporations, application
must be signed by an authorized officer of the corporation. For general or limited partnerships,
application must be signed by a general partner. For LLCs, application must be signed by a
manager or member. For LLPs, application must be signed by a partner. An attorney may sign for
the registrant by including the statement "Attorney for
."
Mail the completed application to the address at the top of the application. If the name of the registrant
is being changed (Line 5a), supporting documentation showing the change of name of the registrant
must be submitted with the application.
There is no fee to file an application to change a registrant’s name and/or address (Form TM04).
FORM TM04 Instructions
INSTRUCTIONS (FORM TM04)
NOTE: This form (Form TM04) is only for changing the name and/or address of the registrant of a
registered trademark or service mark. This form may not be used to assign or transfer ownership of
a registered mark. Use the assignment form (Form TM03) to change the owner of a registered mark
from one person/entity to a different person/entity.
Line 1: Enter the trademark or service mark registration number.
Line 2: Enter the name of the mark as it appears on the records of the Secretary of State’s office.
Line 3: Enter the date of registration of the trademark or service mark.
Line 4. Enter the registrant’s name and business address as it currently appears on the records of the
Secretary of State’s office.
Line 5. Check and complete all that apply.
a. Registrant Name Change – Enter the new name of the registrant, and the effective date of
the name change. Submit supporting documentation showing the change of name of the
registrant.
b. Registrant Address Change – Enter the new business address of registrant, new
mailing address, and/or new secondary email address of the registrant.
Line 6. If registrant is an entity, enter the state or country of incorporation/formation/organization.
Line 7. Sign, date, print the signer’s name, and enter the title of the signer if applicable. Enter the
signer’s email address. Application must be signed by the registrant only. For a registrant that is
an individual, the application must be signed by that individual. For corporations, application
must be signed by an authorized officer of the corporation. For general or limited partnerships,
application must be signed by a general partner. For LLCs, application must be signed by a
manager or member. For LLPs, application must be signed by a partner. An attorney may sign for
the registrant by including the statement "Attorney for
."
Mail the completed application to the address at the top of the application. If the name of the registrant
is being changed (Line 5a), supporting documentation showing the change of name of the registrant
must be submitted with the application.
There is no fee to file an application to change a registrant’s name and/or address (Form TM04).
FORM TM04 Instructions
OFFICE OF SECRETARY OF STATE
CORPORATIONS DIVISION
2 Martin Luther King Jr. Dr. SE
Suite 313 West Tower
Atlanta, Georgia 30334
(404) 656-2817
http://sos.ga.gov/
Secretary of State
TRADEMARK OR SERVICE MARK
REGISTRANT NAME AND/OR ADDRESS CHANGE
F
F
: $0
ILING
EE
T
/
HE UNDERSIGNED HEREBY SUBMITS THIS APPLICATION TO CHANGE THE NAME AND
OR ADDRESS OF THE REGISTRANT OF THE
G
/
:
FOLLOWING
EORGIA TRADEMARK AND
OR SERVICE MARK REGISTRATION
1.
R
N
:___________________________________
EGISTRATION
UMBER
2.
N
M
: _________________________________________________________________________________________
AME OF
ARK
3.
D
R
:____________________________________
ATE OF
EGISTRATION
4.
N
R
(
):__________________________________________________________________
AME OF
EGISTRANT
BEFORE THE CHANGE
B
A
: ______________________________________________________________________________________
USINESS
DDRESS
______________________________________________________________________________________
5.
C
:
HECK AND COMPLETE ALL THAT APPLY
. R
N
C
A
EGISTRANT
AME
HANGE
N
: _________________________________________________________________________
EW NAME OF REGISTRANT
D
: __________________________
ATE NAME CHANGE EFFECTIVE
. R
A
C
B
EGISTRANT
DDRESS
HANGE
N
,
: _______________________________________________________________
EW BUSINESS ADDRESS
IF APPLICABLE
_______________________________________________________________
N
,
: _______________________________________________________________
EW MAILING ADDRESS
IF APPLICABLE
_______________________________________________________________
N
,
: _______________________________________________________
EW SECONDARY EMAIL ADDRESS
IF APPLICABLE
6.
I
,
/
/
:_____________________
F REGISTRANT IS AN ENTITY
LIST STATE OR COUNTRY OF INCORPORATION
FORMATION
ORGANIZATION
7.
I
,
,
I
,
CERTIFY
UNDER THE PENALTY OF PERJURY
THAT
AM AUTHORIZED TO SIGN THIS APPLICATION
AND THAT THE ABOVE
.
STATEMENTS ARE TRUE AND CORRECT
S
R
: _______________________________________________
D
: ________________________
IGNATURE OF
EGISTRANT
ATE
P
N
: ___________________________________________________________
RINT
AME
T
(
): __________________________________________
ITLE
IF SIGNING FOR AN ENTITY
E
: ________________________________________________________________
MAIL
Mail or deliver to the Secretary of State, at the above address, the following:
(1) This completed application; and
(2) Supporting documentation showing the change of name of the registrant, if applicable.
FORM TM04
(Rev 6/2019)
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