Application for a Certificate of Registration of a Trade or Service Mark (Connecticut)
This is an application to register a trade or service mark in Connecticut. The form provided here is simply a sample of what the actual Form TM 500 looks like.
SECRETARY OF THE STATE OFFICE
30 TRINITY STREET, P.O. BOX 150470
HARTFORD, CT 06115-0470
APPLICATION FOR A CERTIFICATE OF REGISTRATION OF A TRADE OR SERVICE MARK
1. Name of Owner of Mark: _________________________
2. Address of Owner:
Zip Code _________________________
3. State or Country of Formation of the Owner, if other than a natural person:
(Partnerships - reference & attach 8 ½ x 11 list of partners)
4. Please provide a complete description of the mark:
5. The goods or services on or in connection with which the mark is used:
6. Use this space to disclaim the exclusive right to use any descriptive, generic or geographically descriptive components of the mark
7. The Class of the goods or services stated in item number 5:
NOTE: One application per good/service.
8. The date on which the mark was first used anywhere:
9. The date on which the mark was first used in Connecticut:
10. The mode, manner or method of applying, affixing or otherwise using the mark on or in connection with such goods or services:
11. Have applications to register the mark or portions or composites thereof been filed in the United States Patent or Trademark Office?
12. If No. 11 was answered Yes, indicate the filing date, serial number, status, and if registration was refused, the reasons for such refusal:
The applicant is the owner of the mark or the owner's representative. The applicant asserts that the mark is not known to be the subject matter of an existing federal registration granted to another and to the best of the applicant's knowledge, no other person has the right to use such mark in this state either in the identical form thereof or in such near resemblance thereto as to be likely, when applied to the goods or services of such other person, to cause confusion, or to cause mistake or to deceive purchasers. The applicant hereby declares under the penalties of false statement that the statements made in the foregoing application are true.
13. Date of Execution _________________________ Month, day, year
14. Name of Applicant if other than Owner
Business Address of Applicant
15. Print/Type name of signatory _________________________
Title of signatory if applicable: _________________________
16. Signature _________________________
17. The applicant must submit three specimens or photographs of the mark as actually used in this state.
Please make appropriate reference to attachments if additional space is needed.
INSTRUCTIONS FOR FILLING OUT THIS FORM
The following series of instructions have been compiled to assist you in completing the Application for Registration of a Connecticut Trade or Service Mark form. Numbers appearing on this instruction correspond with numbered blanks appearing on the form.
Examples provided in these instructions are fictitious and have been included to illustrate applications of the instructions provided.
1. Name of Owner of Mark - Provide full legal name of the individual or organization who or which actually owns the mark.
2. Address of owner of Mark - Provide full street address of mark's owner. Include street, city, state and zip code.
3. State or Country of Formation of the Owner - Complete only if owner is not a natural person by providing the owner's state of formation.
A. Note: if the owner of the mark is a partnership, it must attach a list of its partners to the application.
4. Description of the Mark - Provide in words, a full description of the mark intended to be registered.
A. If the mark is composed of words alone, the description need only restate those words.
1. Example - The mark is SPINTECH. The description is SPINTECH.
B. Logos, pictorial features, colors, or distinctive print styles, which are components of the mark, must be described in writing.
1. Example description - SPINTECH appearing in yellow block letters in the center of three horizontally arrayed silver gears.
C. Please note that the written description defines the registration. All searches conducted by this office are based upon the written description. It is important, therefore, to include all relevant description of the mark in item number 4. Drawings or references to attached specimens will not substitute for a full written description and must not appear in item number 4.
5. The goods or services on or in connection with which the mark is used - Provide the type of the goods or services, which the mark identifies. This is usually a description of what the owner produces, e.g., Tires for a manufacturer of Tires - Real Estate Services for a Real Estate Agency.
6. Disclaimers - The exclusive right to use any generic, descriptive or geographically descriptive terms or features of the mark must be disclaimed on the application. If such terms or features are not disclaimed, the application will have to be returned for correction. Whether or not components of a mark must be disclaimed depends largely upon the goods or services in connection with which it is used.
A. Example -
1. The mark is described as: The words "Quickie Grocery of Meriden" contained within a bright orange triangle.
2. The services in connection with which the mark is used is: Grocery store services.
3. The disclaimer required is: The owner hereby disclaims the exclusive right to use the terms "Grocery" and "Meriden".
7. The class of goods or services - Select from the list of classes provided in section 3.5-l Ih of the Connecticut General Statutes. (this list has been reproduced for your convenience and included within the application package).
A. Select the class into which the goods or services stated in item number 7 fall. If your mark identifies goods, select a class from the group of trademark classes only. Otherwise, if your mark identifies services, select a class from the group of service mark classes only.
B. If you cannot find a class into which your mark falls please choose the appropriate miscellaneous class, 20 for goods, 42 for services.
C. Only one class may be selected per application. Separate applications must be completed for marks, which identify multiple classes of goods or services.
8. The date on which the mark was first used anywhere - Provide month, day and year of the mark's first use anywhere. A. The date of first use anywhere must precede the date on which the application is submitted.
9. The date on which the mark was first used in Connecticut -Provide month, day and year of the mark's first use in Connecticut.
A. The date of first use in Connecticut must precede the date on which the application is submitted.
10. The mode, manner or method of applying,, affixing or otherwise using the mark - Provide the answer to the question: where is the mark placed to identify the goods or services.
A. EXAMPLE - The mark appears on signs, in magazine advertisements and on product labels.
11. Application for registration of the mark with the United States Patent and Trademark office - Answer the question provided in this item "yes" or "no".
12. Specific information regarding registration of the mark with the United States Patent and Trademark Office -
A. Complete only if the answer to the question presented in item number I I is "yes".
B. Provide all of the requested information.
13. Date of Execution: Provide the date on which the application is signed.
14. Name of Applicant:
A: If the owner is applying for registration of the mark, skip over number 14.
B. If the applicant is a person other than the owner, supply the applicant's full legal name and complete business address.
15. Name of Signatory: Print or type the name of the signatory
A. If the owner/applicant is a natural person, leave the Title line blank
B. If the owner/applicant is not a natural person, e.g. a corporation, limited liability company, etc., provide the signatory's title on the Title line.
16. Signature - The signatory named in item number I.5 must provide an original signature.
17. Specimens or photocopies of the mark - All applications must include three identical specimens of the mark or three identical photographs showing the mark as actually used. Examples of specimens include product labels, advertisements, flyers, etc.
Please note that specimens which are derived from newspaper advertisements are not acceptable because they will decay and cannot be maintained as part of this office's permanent records.
A. The specimens or photographs should not be attached to the application.
B. The specimens or photographs should not be larger than 3" X 3".
USE ATTACHMENTS WHERE SPACE PROVIDED IS INADEQUATE.
The following is a list of all statutory classifications for Connecticut Trade and Service Marks. From one of the two possible categories, goods or services, please make the appropriate selection and state the class chosen on the application. Note: trademark registrants may only select from classes of goods and service mark registrants may only select from classes of services. If the goods or services in connection with which your mark is used do not fit squarely within the appropriate list of classes below, please consider selecting one of the miscellaneous classes (20 for goods, 42 for services). See Corm. Gen. Stat. section 35-11 h.
3. Cosmetics and Cleaning Preparations
4. Lubricants and Fuels
6. Metal Goods
8. Hand Tools
9. Electrical and Scientific Apparatus
10. Medical Apparatus
11. Environmental Control Apparatus
15. Musical Instruments
16. Paper Goods and Printed matter
17. Rubber Goods
18. Leather Goods
19. Nonmetallic Building Materials
20. Furniture and Articles not Otherwise Classified
21. Housewares and Glass
22. Cordage and Fibers
23. Yarns and Threads
26. Fancy Goods
27. Floor Coverings
28. Toys and Sporting Goods
29. Meats and Processed Foods
30. Staple Foods
31. Natural Agricultural Products
32. Light Beverages
33. Wines and Spirits
34. Smokers' Articles
35. Advertising and Business
36. Insurance and Financial
37. Construction and Repair
39. Transportation and Storage
40. Material Treatment
41. Education and Entertainment