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Assignment of Registered Mark Owner (Connecticut)

This is to assign a registered mark owner in Connecticut. The form provided here is simply a sample of what the actual Form TM 503 looks like.

OFFICE OF THE SECRETARY OF THE STATE
30 TRINITY STREET
P.O. BOX 150470
HARTFORD, CT 06 1150470

ASSIGNMENT OF REGISTERED MARK OWNER

Rev. 12/1999

1. Current 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 of the mark (the Assignor), hereby assigns to the Assignee and new owner named below, all rights, title and interest to and in mark, together with the good will of the business symbolized by the mark, along with the registration thereof.

4. Name of Assignee: __________________________

5. Address of Assignee:

Street __________________________

City __________________________

State __________________________

Zip Code __________________________

6. State of Formation of the Assignee if other than a natural person:

__________________________

EXECUTION:

I hereby declare under the penalties of false statement that the statements made in the foregoing application is true.

7. Date __________________________

8. Name of Signatory for Assignor __________________________

9. Title of Signatory if applicable __________________________

10. Signature __________________________

11. Date __________________________

12. Name of Signatory for Assignee __________________________

13. Title of Signatory if applicable __________________________

14. Signature __________________________

15. The applicant must submit three specimens or photographs of the mark as actually used in this state.

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