Application for Cancellation of a Mark Owner (Connecticut)
This is an application to cancel a mark owner in Connecticut. The form provided here is simply a sample of what the actual Form TM 504 looks like.
OFFICE OF THE SECRETARY OF THE STATE
30 TRINITY STREET
P.O. BOX 150470
HARTFORD, CT 06 1150470
APPLICATION FOR CANCELLATION OF A REGISTERED MARK OWNER
Rev. 12/1999
1. Name of Record Owner: __________________________
2. State of Formation of the Owner if other than a natural person.
__________________________
3. Connecticut Registration Number: __________________________
The above named owner hereby applies for cancellation of the registration bearing the number stated in item number 3 above.
EXECUTION:
I hereby declare under the penalties of false statement that the statements made in the foregoing application is true.
4. Date __________________________
5. Name of Signatory __________________________
6. Title of Signatory if applicable __________________________
7. Signature __________________________