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Trade and Service Marks--Assignment or Cancellation (Oregon)

This is to assign or cancel a registration for trademark and service mark in Oregon. The form provided here is simply a sample of what the actual Form CR172 looks like.

CR172

Phone: (503) 986-2200
Fax: (503) 378-4381
Secretary of State
Corporation Division
255 Capitol St. NE, Suite 151
Salem, OR 97310-1327

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For office use only

Registry Number: ________________________________

Attach Additional Sheet if Necessary
Please Type or Print Legibly in Black Ink

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Trade and Service Marks--Assignment or Cancellation

1) Correspondent Name And Mailing Address

Address _______________________________

City _______________________________

State _______________________________

Zip _______________________________

2) Applicant's Name And Address (Owner)

Address _______________________________

City _______________________________

State _______________________________

Zip _______________________________

3) Date Mark Was Originally Filed _______________________________

4) Description Of Trade Or Service Mark

_______________________________

_______________________________

ASSIGNMENT ONLY

5) Class Number(s) for Which Mark Was Registered

_______________________________

6) Name and Business Address of Assignee

Name _______________________________

Street Address _______________________________

City _______________________________

State _______________________________

Zip _______________________________

7) If the Assignor is a Corporation, Enter the State of Incorporation.

_______________________________

_______________________________

8) If the Assignee is a Corporation, Enter the State of Incorporation.

_______________________________

9) Execution

Now, therefore, for good and valuable consideration, receipt of which is hereby acknowledged, ASSIGNOR does hereby assign onto the ASSIGNEE all right, title, and interest in and to the mark, together with the good will of the business in which the mark is used (or that part of the good will of the business connected with the use of an symbolized by the mark), and the registration thereof.

Assignor Signature: _______________________________

Title: _______________________________

Date: _______________________________

CANCELLATION ONLY

10) Registry Number _______________________________

11) Execution

Signature: _______________________________

Date: _______________________________

12) Contact Name _______________________________

Daytime Phone Number - Including Area Code ___________________


FEES

Make check for $10 payable to "Corporation Division." Registration is good for five years from the date of registration.

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