The
						Attorney Information page will automatically
						display within this form
						for editing or removing the attorney information appearing
						above. 
 
						 
						Power
						of Attorney: The USPTO
						considers the power of attorney to end: (1) upon the date of
						registration; or (2) the final acceptance or denial of a
						required post-registration filing. Filing this form will
						automatically update the Attorney of Record and the Primary
						Email Address for Correspondence in the USPTO's Trademark
						Status & Document Retrieval (TSDR) database.
						It is not necessary to file a separate appointment
						form. 
Foreign-domiciled
						owners/holders must
						have a U.S.-licensed attorney represent
						them before the USPTO in any application-or
						registration-related filing. Information
						about hiring a U.S.-licensed attorney can
						be found on the USPTO website. 
						 
						 
					 | 
				 
			 
			 
			 
		 | 
	
	
		
			Owner
			Information 
			Instructions: 
Update
			the mailing address, if needed.
			The address entered on this page is publicly viewable in the
			USPTO's TSDR database
			and is presumed to be the owner's/holder's domicile. 
		 | 
	
	
		
			* Owner 
		 | 
		
			 
 
 
 Check
			this box only if the owner listed above does not identify the
			current trademark owner. The trademark owner is the legally
			recognized entity or individual that owns the trademark. 
 
If
			there has been a change in ownership or legal name of the owner,
			you must enter the new owner in this form. Instructions will be
			provided when you check the box. For more information, see
			our webpage
			on modifying owner information in online forms. 
		 | 
	
	
		
			 
 DBA (doing
			business as)  
 AKA
			(also known as) 
 
 TA
			(trading as)  
 Formerly 
		 | 
		
			 
 
		 | 
	
	
		
			Legal
			Entity Type: Corporation 
			Citizenship/State, Country,
			Region, or Jurisdiction Where Organized: Indiana 
 
 
 Check
			this box only if no information is listed in the field/s or if the
			information listed is not correct for the current owner of the
			trademark. 
 
Instructions will be provided when you check
			the box. 
		 | 
	
	
		
			Internal
			Address 
		 | 
		
			 
 
		 | 
	
	
		
			* Mailing
			Address 
(Entered
			address is publicly viewable in the USPTO's 
TSDR database.
			This address must be capable of receiving mail and may be your
			street address, a P.O. box, or a "care of" address.) 
		 | 
		
			 
 
 
NOTE: You
			must limit your entry here, and for all remaining fields within
			this overall section, to no more than 40 characters (the storage
			limit for the USPTO database). You may need to abbreviate some
			words, e.g., St. instead of Street. Failure to do so may result in
			an undeliverable address, due to truncation at the 40 character
			limit. 
		 | 
	
	
		
			* City 
		 | 
		
			 
 
NOTE: You
			must limit your entry here to no more than 22 characters. 
		 | 
	
	
		
			* State 
(Required
			for U.S. owners/holders only) 
		 | 
		
			 
 
NOTE: You
			must include as part of the "City" entry any information
			related to geographical regions (e.g., provinces) not found in the
			dropdown lists for "States" or "Countries."
			Enter the city and then the geographical region, separated by a
			comma (e.g., Toronto, Ontario). In most instances, you will then
			also have to select the country within which the region is found,
			below. 
		 | 
	
	
		
			* Country/Region/Jurisdiction/U.S.
			Territory 
		 | 
		
			                                                                                                                                                                                                                                                  
 
		 | 
	
	
		
			* Zip/Postal
			Code 
(Required
			for U.S. and certain international addresses) 
		 | 
		
			 
 
		 | 
	
	
		
			Domicile
			Address 
(Entered
			address is not publicly viewable in the USPTO's TSDR database
			unless it is the same as the mailing address. If your mailing
			address is not your domicile, you must enter the number, street,
			city, state, country or U.S. territory, and if applicable,
			zip/postal code of your domicile address.
			In most cases, a P.O. box, "care of" address, or similar
			variation is not acceptable as a domicile address.) 
		 | 
		
			 
 Uncheck
			this box if the Domicile Address and mailing address of the
			applicant owner/holder are NOT the same. 
 
 
Indicate
			place you reside and intend to be your principal home (for
			individual) or your principal place of business (for entity). 
		 | 
	
	
		
			Phone
			Number 
		 | 
		
			 
 
		 | 
	
	
		
			Fax
			Number 
		 | 
		
			 
 
		 | 
	
	
		
			* Email
			Address 
Confirm
			that the email address is correct before continuing. The owner
			email address is not publicly viewable in the
			USPTO's TSDR database. 
		 | 
		
			 
 
The
			owner/holder is required to provide an email address and keep that
			address current with the USPTO. If the owner/holder is represented
			by a U.S.-licensed attorney, only the attorney's email address
			will be used for correspondence by the USPTO. 
 
NOTE:
			The owner/holder or the owner's/holder's attorney acknowledges
			that he or she is solely responsible for receiving USPTO emails.
			Additionally, the owner/holder or the owner's/holder's attorney is
			responsible for periodically checking the status of the
			application/registration using the Trademark
			Status & Document Retrieval (TSDR) system.
			USPTO notices and office actions issued in this
			application/registration can be viewed online using TSDR.
			The USPTO is not responsible for any failure to receive a
			USPTO-issued email due to the receiver's security or anti-spam
			software, or any problems with the receiver's email system 
		 | 
	
	
		
			Goods/Services/Collective
			Membership Information 
			 
WARNING: Registration
			Subject to Cancellation for Fraudulent Statements 
You
			must ensure that statements made in filings to the USPTO are
			accurate, as inaccuracies may result in the cancellation of a
			trademark registration. The
			lack of use on all goods/services, or to indicate
			membership in the collective organization for which you claim use
			in a post-registration filing with the USPTO could jeopardize the
			validity of the registration and result in its cancellation. 
		 | 
	
	
		
			Enter
			information for the Class 
		 | 
	
	
		
			* International
			Class:  
Current
			listing of goods/services/nature of the collective membership
			organization: 
 
 
		 | 
	
	
		
			
				
				
				
					
						 
 
					 | 
					
						For
							a trademark or service mark application:
							The owner/holder has continuously used the mark in commerce
							for five (5) consecutive years after the date of registration,
							or the date of publication under Section 12(c), and is still
							using the mark in commerce on or in connection
							with ALL goods/ALL services/to
							indicate membership in the collective membership organization
							listed in the existing registration for this class; For
							a collective trademark, collective service mark, or collective
							membership mark application:
							the owner/holder has continuously exercised legitimate control
							over the use of the mark in commerce by members on or in
							connection with the identified goods/services/collective
							membership organization for five (5) consecutive years after
							the date of registration, or the date of publication under
							Section 12(c), and is still exercising legitimate control over
							the use of the mark in commerce by members on or in connection
							with ALL goods/services, or to indicate membership in the
							collective membership organization listed in the existing
							registration for this class; For
							a certification mark application:
							the owner/holder has continuously exercised legitimate control
							over the use of the mark in commerce by authorized users on or
							in connection with the identified goods/services for five (5)
							consecutive years after the date of registration, or the date
							of publication under Section 12(c), and is still exercising
							legitimate control over the use of the mark in commerce by
							authorized users on or in connection with ALL goods/services
							listed in the existing registration for this class. Also,
							there has been no final decision adverse to the
							owner's/holder's claim of ownership of such mark for those
							goods/services, or to indicate membership in the collective
							membership organization, or to the owner's/holder's right to
							register the same or to keep the same on the register; and,
							there is no proceeding involving said rights pending and not
							disposed of in either the U.S. Patent and Trademark Office or
							in a court. 
						 
					 | 
				 
			 
			 
			 
		 | 
	
	
		
			
				
				
				
					
						 
 
					 | 
					
						The
						filing does not cover
						this specific class. 
					 | 
				 
			 
			 
			 
		 | 
	
	
		
			
				
				
				
					
						 
 
					 | 
					
						For
						a trademark or service mark application:
						The owner/holder has continuously used the mark in commerce for
						five (5) consecutive years after the date of registration, or
						the date of publication under Section 12(c), and is still using
						the mark in commerce on or in connection
						with ALL goods/services
						listed in the existing registration for this class; For
						a collective trademark, collective service mark, or collective
						membership mark application:
						the owner/holder has continuously exercised legitimate control
						over the use of the mark in commerce by members on or in
						connection with the identified goods/services for five (5)
						consecutive years after the date of registration, or the date
						of publication under Section 12(c), and is still exercising
						legitimate control over the use of the mark in commerce by
						members on or in connection with ALL goods/services listed in
						the existing registration for this class; For
						a certification mark application:
						the owner/holder has continuously exercised legitimate control
						over the use of the mark in commerce by authorized users on or
						in connection with the identified goods/services for five (5)
						consecutive years after the date of registration, or the date
						of publication under Section 12(c), and is still exercising
						legitimate control over the use of the mark in commerce by
						authorized users on or in connection with ALL goods/services
						listed in the existing registration for this class. Also, there
						has been no final decision adverse to the owner's/holder's
						claim of ownership of such mark for those goods/services or to
						the owner's/holder's right to register the same or to keep the
						same on the register; and, there is no proceeding involving
						said rights pending and not disposed of in either the U.S.
						Patent and Trademark Office or in a court. 
						 
 
THE
						ABOVE STATEMENT IS ENTIRELY TRUE, EXCEPT FOR
						THE GOODS/SERVICES LISTED BELOW. THIS FILING SPECIFICALLY
						DOES NOT COVER
						THE FOLLOWING GOODS/SERVICES: 
 
						 
						 
 
						 
						 
						 
						 
						 
						 
						 
						 
						 
						 
					 | 
				 
				
					
						IN
						THE FOLLOWING SPACE, PROPOSE HOW THE COMPLETE "FINAL"
						LISTING SHOULD APPEAR, ONLY SPECIFY THOSE GOODS/SERVICES TO
						WHICH THE SECTION 15 AFFIDAVIT/DECLARATION PERTAINS. ALTHOUGH
						SOME GOODS/SERVICES MAY BE OMITTED FROM THE LISTING, NO OTHER
						MODIFICATION OF ANY WORDING IN THE IDENTIFICATION IS
						PERMITTED. 
 
 
						 
						
						 
 
						
						 
 
						 
						
						 
 
						 
						
						 
 
						 
						
						 
 
						 
						
						 
 
						 
						
						 
 
						 
						 
						 
					 | 
				 
			 
			 
			 
		 | 
	
	
		
			Attorney
			Information 
		 | 
	
	
		
			* Attorney
			Name 
		 | 
		
			 
 
		 | 
	
	
		
			Firm
			Name 
		 | 
		
			 
 
		 | 
	
	
		
			Docket/Reference
			Number 
		 | 
		
			 
 
NOTE: You
			must limit your entry here to no more than 12 characters. 
		 | 
	
	
		
			* Bar
			Membership 
		 | 
		
			 
			 
		 | 
	
	
		
			* Year
			of Admission  
 
		 | 
	
	
		
			* U.S.
			State/Commonwealth/Territory  
 
		 | 
	
	
		
			* Membership
			Number  
 
You
			must enter "N/A" or a membership/registration number if
			your U.S. state, commonwealth, or territory issues one. This
			number is not viewable in TSDR. 
You must limit your entry
			here to no more than 40 alphanumeric characters. 
			 
 * The
			attorney of record is an active member in good standing of the bar
			of the highest court of a U.S. state, the District of Columbia, or
			any U.S. Commonwealth or territory. 
		 | 
	
	
		
			Other
			Appointed Attorney(s) 
		 | 
		
			 
 
		 | 
	
	
		
			Recognized
			Canadian 
Attorney/Agent 
		 | 
		
			 
 
		 | 
	
	
		
			Internal
			Address 
		 | 
		
			 
 
		 | 
	
	
		
			* Street
			Address 
		 | 
		
			 
 
NOTE: You
			must limit your entry here, and for all remaining fields within
			this overall section (except City, see below),
			to no more than 40 characters (the storage limit for the USPTO
			database). You may need to abbreviate some words, e.g., St.
			instead of Street. Failure to do so may result in an undeliverable
			address, due to truncation at the 40 character limit. 
		 | 
	
	
		
			* City 
		 | 
		
			 
 
NOTE: You
			must limit your entry here to no more than 22 characters. 
		 | 
	
	
		
			* State 
(Required
			for U.S. addresses) 
		 | 
		
			 
 
NOTE: You
			must include as part of the "City" entry any information
			related to geographical regions (e.g., provinces) not found in the
			dropdown lists for "States" or "Countries."
			Enter the city and then the geographical region, separated by a
			comma (e.g., Toronto, Ontario). In most instances, you will then
			also have to select the country within which the region is found,
			below. 
		 | 
	
	
		
			* Country/Region/Jurisdiction/U.S.
			Territory 
		 | 
		
			                                                                                                                                                                                                                                                  
 
		 | 
	
	
		
			* Zip/Postal
			Code 
(Required
			for U.S. and certain international addresses) 
		 | 
		
			 
 
		 | 
	
	
		
			Phone
			Number 
		 | 
		
			 
 
		 | 
	
	
		
			Fax
			Number 
		 | 
		
			 
 
		 | 
	
	
		
			* Email
			Address 
		 | 
		
			 
 
The
			appointed attorney's email address must be provided and kept
			current with the USPTO. 
 
NOTE:
			The owner/holder or the owner's/holder's attorney acknowledges
			that he or she is solely responsible for receiving USPTO emails.
			Additionally, the owner/holder or the owner's/holder's attorney is
			responsible for periodically checking the status of the
			application/registration using the Trademark
			Status & Document Retrieval (TSDR) system.
			USPTO notices and office actions issued in this
			application/registration can be viewed online using TSDR.
			The USPTO is not responsible for any failure to receive a
			USPTO-issued email due to the receiver's security or anti-spam
			software, or any problems with the receiver's email system. 
		 | 
	
	
		
			Correspondence
			Information 
			To
			make changes to the Primary
			Email Address for Correspondence below,
			either 
(1) return to the Owner Information section (if no
			attorney has been appointed) and enter the change, or 
(2) use
			the Attorney Information section of the form to enter the change
			(if an attorney has been appointed). 
		 | 
	
	
		
			Name 
		 | 
		
			 
			 
		 | 
	
	
		
			Email
			Address 
		 | 
		
			Primary
			Email Address for Correspondence: 
			 
Secondary Email Address(es)
			(Courtesy Copies)  
 
Enter
			up to 4 addresses, separated by either a semicolon or
			a comma. 
Only
			the Primary Email Address is used for official communication by
			the USPTO. The owner/holder or the owner's/holder's appointed
			attorney must keep this email address current. The owner/holder or
			the owner's/holder's appointed attorney may provide Secondary
			Email Addresses for receiving courtesy copies. 
		 | 
	
	
		
			Miscellaneous
			Information 
		 | 
	
	
		
			To
			attach your file, please note that: 
*Click
			on the 'Attach' button to select the file in JPG/PDF format (not
			exceeding 5 megabytes per attachment for JPG or 30 megabytes per
			attachment for PDF) or .WAV, .WMV, .WMA, .MP3, .MPG, or .AVI
			format (not exceeding 5 megabytes for sound files or 30 megabytes
			for motion files). 
			 0file(s)
			attached 
			Miscellaneous
			Statement: Enter
			information for which no other section of the form is appropriate. 
		 | 
	
	
		
			
				
				
					| 
						
						  
						 
					 | 
				 
				
					
						
							
							
							
								
									Section
									15 Filing Fee: $200 
								 | 
							 
							
								
									      Number
									of Classes 
								 | 
								
									   
								 | 
							 
							
								
									      Note: The
									filing fee is computed based on the Number of Classes in
									which the goods/services/collective membership organization
									associated with the mark is/are classified. 
								 | 
							 
							
								
									      Section
									15 Filing Fee 
      (Number of Classes x
									$200 (per class)) 
								 | 
								
									 
$  
								 | 
							 
							
								
									Total
									Fee Paid 
								 | 
							 
							
								
									        Amount
									Section 15 Filing Fee 
								 | 
								
									$  
								 | 
							 
						 
						 
						 
					 | 
				 
				
					
						 
						 
						
						 
						 
					 | 
				 
			 
			 
			 
		 | 
	
	
		| 
			
			  
			 
		 | 
	
	
	
		
			
				
				
				
				
				
					
						* Signature 
					 | 
					
						 
 
Examples
						of acceptable "signatures" include: /john doe/; /jd/;
						or /123-4567/. 
NOTE: Must
						be personally signed by the individual listed in the
						Signatory's Name field. 37
						C.F.R. §2.193(a). The
						person signing may not enter someone else's signature. 
Only
						one signature is required, regardless of the number of
						owners/holders. 
					 | 
					
						* Date
						Signed 
					 | 
					
						 
 (MM/DD/YYYY) 
					 | 
				 
				
					
						* Signatory's
						Name 
					 | 
					
						 
 
					 | 
				 
				
					
						* Signatory's
						Position 
					 | 
					
						 
 
Enter
						appropriate title or nature of relationship to the
						owner/holder. 
 
If the signer is 
- An individual
						owner/holder, enter "Owner"
						or "Holder" as appropriate. 
- Joint
						individual owners/holders,
						enter "Owners" or "Holders" as
						appropriate. 
- A business
						entity authorized
						signatory, enter official title; e.g., "President"
						(if a corporation),"General Partner" (if a
						partnership), or "Principal" (if a limited liability
						company). 
- A U.S.-licensed attorney,
						enter "Attorney of record," and if not specified in
						the application or prior communications, specify at least one
						state bar admission, e.g., "Attorney of record, New York
						Bar member." Also, if the signing attorney is from the
						same U.S. firm as the attorney of record, but was not listed in
						the original filing and is not otherwise of record, also
						include law firm name, e.g., Associate Attorney, Smith, Jones &
						Davis, Virginia Bar member. 
					 | 
				 
				
					
						Signatory's
						Phone Number 
					 | 
					
						 
 
					 | 
				 
			 
			 
			 
		 | 
	
	
		
			 STEP
			1: Review the application
			data in various formats, by clicking on the phrases under
			Application Data. Use the print function within your browser to
			print these pages for your own records. 
Note: It
			is important that you review this information for accuracy and
			completeness now. Corrections after submission may not be
			permissible, thereby possibly affecting your legal rights. 
			
				
			
			 
			 
		 | 
	
	
		
			 
 STEP
			2: If any of the information
			is incorrect, click on the Go Back to Modify button below to make
			changes; then re-validate using the Validate button at the bottom
			of the Declaration of Incontestability of a Mark under Section 15.
			If there are no errors and you are ready to file electronically,
			first use your print function within your browser to print each of
			these pages for your own records. Then, click on the Pay/Submit
			button below. This will bring up a screen for you to enter the
			appropriate payment information. After successful entry of the
			payment information, you will be able to complete the submission
			to the USPTO. 
		 | 
	
	
		
			 
 STEP
			3: If there are no errors
			and you are ready to file, confirm the Primary
			Email Address for Correspondence,
			displayed below. To make changes to this email address, use the
			navigation buttons below to return to the appropriate page in the
			form and update either the attorney's email address, if appointed,
			or the applicant owner's/holder's email address. Courtesy
			copies are also permitted
			and these email address(es) are displayed below. To update these
			addresses, use the navigation buttons below to return to the
			Correspondence Information page and enter the changes. 
 
After
			you submit the form, the USPTO will send an acknowledgment of
			receipt to the following email address(es): 
			
				
					
					
						
							
								
								
								
									
										Primary
										Email Address for Correspondence 
									 | 
									
										 
										 
									 | 
								 
								
									
										Secondary
										Email Address(es) (Courtesy Copies) 
									 | 
									
										 
										 
									 | 
								 
							 
							 
							 
						 | 
					 
				 
			
			 
			 
		 | 
	
	
		
			 
 STEP
			4: Read and check the
			following: 
			
				
					
					
						
							
								
								
									
										Important
										Notice: 
									 | 
								 
								
									
										(1)
										Once you submit a Declaration of Incontestability of a Mark
										under Section 15, either electronically or through the
										mail, we will not refund your fee, because it is a
										processing fee for our substantive review. 
(2) All
										information you submit to the USPTO at any point in the
										application and/or registration process will become public
										record, including your name, phone number, email address,
										and street address. By filing this document, you
										acknowledge and agree that YOU
										HAVE NO RIGHT TO CONFIDENTIALITY in
										the information disclosed. The public will be able to view
										this information in the USPTO's on-line databases and
										through internet search engines and other on-line
										databases. This information will remain public even if the
										application is abandoned or any registration is
										surrendered, cancelled, or expired. To maintain
										confidentiality of banking or credit card information, only
										enter payment information in the secure portion of the site
										after validating your form. For any information that may be
										subject to copyright protection, by submitting it to the
										USPTO, the filer is representing that he or she has the
										authority to grant, and is granting, the USPTO permission
										to make the information available in its on-line database
										and in copies of the application or registration
										record. 
(3) Be aware that private
										companies not associated
										with the USPTO often use trademark application and
										registration information from the USPTO's databases to mail
										or email trademark-related solicitations (samples
										of non-USPTO solicitations included). 
 
 
 If
										you have read and understand the above notice, please check
										the box before you click on the Pay/Submit button. 
									 | 
								 
							 
							 
							 
						 | 
					 
				 
			
			 
			 
		 | 
	
	
		
			 
 STEP
			5: To download and save the
			form data, click on the Save
			Form button at the bottom of
			this page. The information will be saved to your local drive. To
			begin the submission process with saved data, you must open a new
			form, and click on the "Browse/Choose File" button
			displayed on the initial form wizard page, at "[OPTIONAL]
			To access previously-saved data, use the "Browse/Choose File"
			button below to access the file from your local drive."
			REMINDER: Do NOT try
			to open the saved .obj form directly. You must return to the very
			first page of the form, as if
			starting a brand new form, and
			then use the specific "Browse/Choose File" button on
			that page to import the saved file. Clicking on the "Continue"
			button at the bottom of that first page will then properly open
			the saved version of your form. 
		 | 
	
	
		
			 
 STEP
			6: If you are ready to file
			electronically: 
Click on the Pay/Submit button, below, to
			access the site where you will select one of three possible
			payment methods. After successful entry of payment information,
			you can complete the submission to the USPTO. A valid transaction
			will result in a screen that says SUCCESS! Also,
			we will send an email acknowledgment within 24
			hours. 
WARNING: Click
			on the Pay/Submit button below ONLY if
			you are now entirely prepared to complete the Pay/Submit process.
			After clicking the button, you can NOT return
			to the form, since you will have left the TEAS site entirely. Once
			in the separate payment site, you must complete the Pay/Submit
			process within 30 minutes. If you are not prepared to complete the
			process now, you should select the "Save Form" option to
			save your form, and then complete the Pay/Submit process later.
			Or, if you have discovered any error, use the "Go Back to
			Modify" button to make a correction. 
WARNING: You
			can NOT make
			any fee payments by credit
			card from 2 a.m. to 6 a.m.
			Sunday ET. To file during this specific period, you must use
			either the deposit account or electronic funds transfer payment
			method; or, you may use the "Save Form" option to save
			your form, and then complete the Pay/Submit process at a later
			time with the credit card payment option. 
		 |