Form DSCB:5401114/1115 "Renewal/Assignment of Trademark or Service Mark" - Pennsylvania

Form DSCB:5401114/1115 Printable Pdf
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What Is Form DSCB:5401114/1115?

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

Form Details:

  • Released on July 1, 2015;
  • The latest edition provided by the Pennsylvania 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 DSCB:5401114/1115 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of State.

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Download Form DSCB:5401114/1115 "Renewal/Assignment of Trademark or Service Mark" - Pennsylvania

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PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Return document by mail to:
Trademark/Service Mark
Renewal or Assignment
Name
DSCB:54-1114/1115 (rev. 7/2015)
Address
*11145*
City
State
Zip Code
11145
Return document by email to:
_________________________________
Read all instructions prior to completing.
Fee: $50 - Renewal
$50 - Assignment
Check one:
Renewal of Registration of Mark (§ 1114)
Assignment of Registration of Mark (§ 1115)
In compliance with the requirements of the applicable provisions (relating to duration and renewal or relating to
assignment), the undersigned, having heretofore duly registered a trademark or service mark in this Commonwealth and
desiring to renew/assign such registration, hereby states that:
1. Check one pertaining to registration:
Renewal: The name and description of the mark is (a specimen of the mark the registration of
which is to be renewed showing actual use of the mark on or in conjunction with the goods or
services accompanies this application as Exhibit A and is incorporated herein by reference):
Assignment: The name and description of the mark is (a facsimile of the mark the registration
of which is to be assigned accompanies this assignment as Exhibit A and is incorporated herein by
reference):
2. The residence, location or place of business of the applicant/assignor is:
Number and street
City
State
Zip
County
PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Return document by mail to:
Trademark/Service Mark
Renewal or Assignment
Name
DSCB:54-1114/1115 (rev. 7/2015)
Address
*11145*
City
State
Zip Code
11145
Return document by email to:
_________________________________
Read all instructions prior to completing.
Fee: $50 - Renewal
$50 - Assignment
Check one:
Renewal of Registration of Mark (§ 1114)
Assignment of Registration of Mark (§ 1115)
In compliance with the requirements of the applicable provisions (relating to duration and renewal or relating to
assignment), the undersigned, having heretofore duly registered a trademark or service mark in this Commonwealth and
desiring to renew/assign such registration, hereby states that:
1. Check one pertaining to registration:
Renewal: The name and description of the mark is (a specimen of the mark the registration of
which is to be renewed showing actual use of the mark on or in conjunction with the goods or
services accompanies this application as Exhibit A and is incorporated herein by reference):
Assignment: The name and description of the mark is (a facsimile of the mark the registration
of which is to be assigned accompanies this assignment as Exhibit A and is incorporated herein by
reference):
2. The residence, location or place of business of the applicant/assignor is:
Number and street
City
State
Zip
County
DSCB:54-1114/1115 – 2
3.
Check one pertaining to registration:
Renewal: The name of the applicant is (see instruction D):
Assignment: The name of the assignor and present owner of record of the mark is (if a
corporation, also give jurisdiction of incorporation):
4. The general class in which the existing registration/registration to be assigned applies is:
5. (a) The date when the mark was first registered is: ________________________________________
(b) The date of last renewal of the registration is: _________________________________________
RENEWAL: Complete Paragraphs 6, 7 & 8
6. (Strike out if inapplicable): The present applicant is entitled to make the present application by virtue
of an assignment to the applicant recorded with the Department of State on
showing
an assignment from:
Date
Name of Assignor
. The date, if any, an application to register the mark, or portions or a composite thereof, was filed by
7
the applicant or a predecessor in interest in the United States Patent and Trademark Office. Also
provide filing date and serial number of each application, the status thereof and, if any application was
finally refused registration, or has otherwise not resulted in a registration, the reasons, therefore. (Please
attach 8½ x 11 sheet(s) if more space is needed).
8.
The mark to be renewed is still in use in this Commonwealth.
DSCB: 54-1114/1115-3
ASSIGNMENT: Complete Paragraphs 9, 10, 11 & 12
9.
The mark is being assigned with the goodwill of the business connected with its use or with that part
of the goodwill of the business connected with the use of and symbolized by the mark.
10. The mark is hereby assigned to and the name of the assignee of the mark is (if a corporation, also give
jurisdiction of incorporation):
11. The residence, location or place of business of the assignee is:
Number and street
City
State
Zip
County
12. (Strike out if inapplicable): The present assignor is entitled to make the present assignment by virtue of a
previous assignment to the present assignor recorded with the Department of State on
.
Date
Name of Previous Assignor
IN TESTIMONY WHEREOF, the undersigned person
has caused this Application for Renewal of Registration of
Mark/Assignment of Registration of Mark to be executed
this
day of
,
.
Name of Applicant/Assignor
Signature
Title
DSCB:54-1114/1115–Instructions
Pennsylvania Department of State
Bureau of Corporations and Charitable Organizations
P.O. Box 8722
Harrisburg, PA 17105-8722
(717) 787-1057
Web site: www.dos.pa.gov/corps
General Instructions for Completion of Form:
A. Typewritten is preferred. If handwritten, the form shall be legible and completed in black or blue-black ink in order to
permit reproduction. The nonrefundable filing fee for Renewal of Registration of Mark is $50 and Assignment of
Registration of Mark is $50, made payable to the Department of State. Checks must contain a commercially pre-
printed name and address.
Enter the name and mailing address to which any correspondence regarding this filing should be sent. This field must
be completed for the Bureau to return the filing. If the filing is to be returned by email, an email address must be
provided. An email will be sent to address provided, containing a link and instructions on how a copy of the filed
document or correspondence may be downloaded. Any email or mailing addresses provided on this form will become
part of the filed document and therefore public record.
B. This form and all accompanying documents shall be mailed to the above stated address.
Instructions for Renewal Only:
D. If a corporation, set forth the name in Paragraph 1 and also give jurisdiction of incorporation. If a partnership, set forth
the name in Paragraph 1 and also give the jurisdiction in which the partnership is organized and the names of the
general partners.
E. The name of a commercial registered office provider may not be used in Paragraph 2 in lieu of an address.
F. If the chain of title to the registration includes more than one assignment, Paragraph 6 should be modified accordingly.
Only assignments during the immediately preceding term shall be set forth.
G. This renewal is effective for a term of 5 (five) years from the expiration date. Application to renew for a similar term
must be made on this form within 6 (six) months prior to the expiration date.
Instructions for Assignment Only:
H. The name of a commercial registered office provider may not be used in Paragraph 2 and 11 in lieu of an address.
I. If the chain of title to the registration includes more than one assignment, Paragraph 12 should be modified
accordingly. Only assignments during the current term shall be set forth.
J. If the instrument evidencing the assignment and signed by the assignor is in a different format than this form, the
assignee may execute and attach this form as a cover sheet to a copy of the definitive assignment instrument.
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