Form DOS-0241-F-L-A "Original Application to Register a Trademark" - New York

What Is Form DOS-0241-F-L-A?

This is a legal form that was released by the New York State Department of State - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2014;
  • The latest edition provided by the New York State Department 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 DOS-0241-F-L-A by clicking the link below or browse more documents and templates provided by the New York State Department of State.

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Download Form DOS-0241-F-L-A "Original Application to Register a Trademark" - New York

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New York State Department of State
REG NO
Division of Corporations, State Records and Uniform Commercial Code
One Commerce Plaza, 99 Washington Avenue
Albany, NY 12231-0001
http://www.dos.ny.gov
Original Application to Register a Trademark
Please read the instructions prior to completing this form; attach additional sheets as needed.
1. APPLICANT NAME
2. ADDRESS
NUMBER AND STREET
CITY
STATE
ZIP
3. IF A CORPORATION, ENTER STATE IN WHICH INCORPORATED AND
IF A PARTNERSHIP, ENTER STATE IN WHICH ORGANIZED
4. IF A PARTNERSHIP, LIST THE NAMES OF ALL GENERAL PARTNERS
5. DESCRIBE THE TRADEMARK, INCLUDING A WRITTEN DESCRIPTION OF DESIGN FEATURES, IF ANY (DO NOT GLUE A FACSIMILE TO THIS FORM)
6. DESCRIBE THE SPECIFIC GOODS BEING PRODUCED ON WHICH THE TRADEMARK IS USED
7. STATE THE MANNER IN WHICH THE TRADEMARK IS PLACED ON THE GOODS, CONTAINERS, ETC.
8. CLASS NUMBER(S)
9. DATE OF
(A) IN NEW YORK STATE
(B) ANYWHERE
FIRST USE
FOR OFFICE USE ONLY
The applicant is the owner of the mark, the mark is in use, and, to the knowledge of the person
verifying the application, no other person has registered, either federally or in this state, or has the
right to use such mark either in the identical form or in such near resemblance as to be likely, when
applied to the goods of such other person, to cause confusion, or to cause mistake, or to deceive.
The undersigned applies to register the aforesaid mark pursuant to Article 24 of the General
Business Law and affirms under the penalties of perjury that the statements herein made, including
any attached papers, are true.
(Corporation, Association, Firm, etc.)
By:
(Signature and Title of Officer)
(Date)
Page 1 of 2
DOS-0241-f-l-a (Rev. 04/14)
New York State Department of State
REG NO
Division of Corporations, State Records and Uniform Commercial Code
One Commerce Plaza, 99 Washington Avenue
Albany, NY 12231-0001
http://www.dos.ny.gov
Original Application to Register a Trademark
Please read the instructions prior to completing this form; attach additional sheets as needed.
1. APPLICANT NAME
2. ADDRESS
NUMBER AND STREET
CITY
STATE
ZIP
3. IF A CORPORATION, ENTER STATE IN WHICH INCORPORATED AND
IF A PARTNERSHIP, ENTER STATE IN WHICH ORGANIZED
4. IF A PARTNERSHIP, LIST THE NAMES OF ALL GENERAL PARTNERS
5. DESCRIBE THE TRADEMARK, INCLUDING A WRITTEN DESCRIPTION OF DESIGN FEATURES, IF ANY (DO NOT GLUE A FACSIMILE TO THIS FORM)
6. DESCRIBE THE SPECIFIC GOODS BEING PRODUCED ON WHICH THE TRADEMARK IS USED
7. STATE THE MANNER IN WHICH THE TRADEMARK IS PLACED ON THE GOODS, CONTAINERS, ETC.
8. CLASS NUMBER(S)
9. DATE OF
(A) IN NEW YORK STATE
(B) ANYWHERE
FIRST USE
FOR OFFICE USE ONLY
The applicant is the owner of the mark, the mark is in use, and, to the knowledge of the person
verifying the application, no other person has registered, either federally or in this state, or has the
right to use such mark either in the identical form or in such near resemblance as to be likely, when
applied to the goods of such other person, to cause confusion, or to cause mistake, or to deceive.
The undersigned applies to register the aforesaid mark pursuant to Article 24 of the General
Business Law and affirms under the penalties of perjury that the statements herein made, including
any attached papers, are true.
(Corporation, Association, Firm, etc.)
By:
(Signature and Title of Officer)
(Date)
Page 1 of 2
DOS-0241-f-l-a (Rev. 04/14)
Instructions: Please refer to the
instruction sheet
for completion of items 1 through 9 of the registration form.
Definition: The term “trademark” means any word, name, symbol or device or any combination thereof used
by a person to identify and distinguish the goods of such person, including a unique product, from those
manufactured and sold by others, and to indicate the source of the goods, even if the source is unknown.
General Classes of Goods: Please refer to the
classification
of goods and services.
Please note there is a $50 filing fee for EACH CLASSIFICATION claimed for registration.
Application Form: The application must be on a current form supplied by the Department of State and be
completed in the English language and plainly written or typed. If the mark or any part thereof is not in the
English language, it must be accompanied by a sworn, notarized, translation.
Specimens of the Mark: The application must be accompanied by three specimens (examples) showing the
mark as actually used. Specimens are not to be stapled or glued to the form.
Mail to: Please mail the completed application form together with the filing fee and three specimens of the
mark to: New York State Department of State, State Records, One Commerce Plaza,
99 Washington Avenue, Albany, NY 12231-0001.
Questions: If you have any questions, call (518) 473-2492.
Payment: Checks or money orders should be made payable to the “Department of State.” Please do not send
cash through the mail.
Page 2 of 2
DOS-0241-f-l-a (Rev. 04/14)
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