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Name Change of Registered Mark Owner (Connecticut)

This is to change a registered mark owner's name in Connecticut. The form provided here is simply a sample of what the actual Form TM 502 looks like.

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

NAME CHANGE 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: __________________________

4. The name of the mark's owner been changed to:

__________________________

EXECUTION:

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

5. Date __________________________

6. Name of Signatory __________________________

6. Title of Signatory if applicable __________________________

7. Signature __________________________

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

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