Vermont Secretary of State, 128 State Street, Montpelier, VT 05633-1104(802-828-2386)
NAME OF TRADEMARK
NAME OF OWNER
(street)
(city)
(state/zip)
DESCRIPTION OF PRODUCT:
EXPLAIN HOW MARK IS USED IN CONNECTION WITH THE PRODUCT:
Note: Include the label, package, or picture that clearly shows the trademark and how it will be attached
to the product.
NUMERICAL CLASS OF GOODS: (to see list click here: Trademark Classifications) DATE WHEN TRADEMARK WAS FIRST USED OR ADOPTED: I certify, under penalty of perjury, that the foregoing information is accurate and that no other person
has the right to the trademark, either in the identical form, or having such
near resemblance thereto as may be calculated to deceive, or that would be
liable to be mistaken therefore. Printed Name: Signature: ____________________________________________________________________
Date:
GENERAL NATURE OF APPLICANT'S BUSINESS:
$20.00 FEE payable to Vermont Secretary of State - Registration
is valid for a period of ten years.