State of Vermont

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Office of the Secretary of State

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The form below can be printed out by hitting "Print" on your web browser. Web pages tend to print out in a long format; therefore, a more compact version of this form can be saved and printed out in the following standard word processor formats:
• trdmark.doc -- DOC -- Microsoft Windows, Word, WordPad format
• trdmark.wpd -- WPD -- WordPerfect Document format
• trdmark.rtf -- RTF -- Rich Text Format
• trdmark.txt -- TXT -- simple text format

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NAME OF TRADEMARK_____________________________________

Names and residences of all persons, copartners or the corporate name and the location of the principal office of such corporation.

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name street city state/zip

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name street city state/zip

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name street city state/zip

General nature of applicant's business:

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Description of goods:

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Explain how mark is used in connection with the goods:

___________________________________________________________________

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A FACSIMILE, COPY OR COUNTERPART OF TRADEMARK IN EACH CLASS MUST BE ATTACHED, IN DUPLICATE.

Numerical classification of goods: (see TRADEMARK CLASSIFICATIONS (tmclass.htm)
#________________________________________________

Date when trademark was first used or adopted:_____________

I certify 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 therefor.

Signature of applicant(s)_____________________________________________
(each applicant or their duly authorized officer must sign)

_________________________________________________________________

_________________________________________________________________

Subscribed and sworn to before me this_______ day of______________

Notary Public signature/commission expiration date:

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$10.00 FILING FEE MUST BE ATTACHED.