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Service Mark Application
SERVICE MARK APPLICATION PRINCIPAL REGISTER--WITH DECLARATION
REGISTRATION OF SERVICE MARK IN THE UNITED STATES PATENT AND TRADEMARK OFFICE
Mark
Class Number
TO THE COMMISSIONER OF PATENTS AND TRADEMARKS:
[Insert appropriate identification of applicant:]
The above identified applicant has adopted and is using the service mark shown in the accompanying drawing for [common, usual or ordinary name of service] and requests that such mark be registered in the United States Patent and Trademark Office on the Principal Register established by the Act of July 5, 1946.
The service mark was first used in connection with the services on [date]; was first used in connection with the services rendered in [type of commerce] commerce on [date]; and is now in use in such commerce.
The mark is used by [state method of using the mark in connection with the services], and five [specimens or state nature of furnished representation of mark] showing the mark as actually used are presented herewith.
DECLARATION
Insert appropriate declaration from those set forth below:
If applicant is an individual, state:
[Name of applicant], being hereby warned that willful false statements and the like so made are punishable by fine or imprisonment, or both, under Section 1001 of Title 18 of the United States Code and that such willful false statements may jeopardize the validity of the application or any registration resulting therefrom, declares that:
1. [He or She] believes [himself or herself] to be the owner of the service mark sought to be registered;
2. To the best of [his or her] knowledge and belief no other person, firm, corporation or association has the right to use the mark in commerce, either in the identical form or in such near resemblance thereto as may be likely, when applied to the services of such other person, to cause confusion, or to cause mistake, or to deceive;
3. The facts set forth in this application are true;
4. All statements made in this application of [his or her] own knowledge are true and all statements made on information and belief are believed to be true; and
5. These statements were made with the knowledge that willful false statements and the like so made are punishable by fine or imprisonment, or both, under Section 1001 of Title 18 of the United States Code and that such willful false statements may jeopardize the validity of the application or document or any registration resulting therefrom. Dated:
Signature of applicant Date
If applicant is a partnership, state:
[Name of partner], being hereby warned that willful false statements and the like so made are punishable by fine or imprisonment, or both, under Section 1001 of Title 18 of the United States Code and that such willful false statements may jeopardize validity of the application or any registration resulting therefrom, declares that:
1. [He or She] is a partner of applicant partnership;
2. [He or She] believes such partnership to be the owner of the service mark sought to be registered;
3. To the best of [his or her] knowledge and belief no other person, partnership, corporation or association has the right to use such mark in commerce, either in the identical form or in such near resemblance to it as may be likely, when applied to the services of such other person, to cause confusion, or to cause mistake, or to deceive;
4. All statements made in this application of [his or her] own knowledge are true and all statements made on information and belief are believed to be true; and
5. These statements were made with the knowledge that willful false statements and the like so made are punishable by fine or imprisonment, or both, under Section 1001 of Title 18 of the United States Code and that such willful false statements may jeopardize the validity of the application or document or any registration resulting therefrom.
Signature of partner Date
If applicant is a corporation, state:
[Name of corporate officer], being hereby warned that willful false statements and the like are punishable by fine or imprisonment, or both, under Section 1001 of Title 18 of the United States Code and that such willful false statements may jeopardize the validity of the application or any registration resulting from it, declares that:
1. [He or She] is [official title] of applicant corporation and is authorized to execute this instrument on behalf of the corporation;
2. [He or She] believes the corporation to be the owner of the service mark sought to be registered;
3. To the best of [his or her] knowledge and belief no other person, firm, corporation or association has the right to use the mark in commerce, either in the identical form or in such near resemblance to it as may be likely, when applied to the services of such other person, to cause confusion or mistake, or to deceive;
4. All statements made in this application of [his or her] own knowledge are true and all statements made on information and belief are believed to be true; and
5. These statements were made with the knowledge that willful false statements and the like so made are punishable by fine or imprisonment, or both, under Section 1001 of Title 18 of the United States Code and that such willful false statements may jeopardize the validity of the application or document or any registration resulting therefrom.
Corporate name Date
By
Signature of corporate officer and official title
Signature of applicant
Attach designation of domestic representative, if necessary.