Withdrawal Domestic Representative

PYCNOGENOL

HORPHAG RESEARCH MANAGEMENT S.A.

Request to withdraw as Domestic Representative

Under the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number.
PTO Form No Form Number (Rev 01/2012)
OMB No. 0651-0056 (Exp 09/30/2017)

Request to withdraw as Domestic Representative


The table below presents the data as entered.

Input Field
Entered
SERIAL NUMBER 74022937
REGISTRATION NUMBER 1769633
MARK SECTION
MARK PYCNOGENOL
STANDARD CHARACTERS YES
USPTO-GENERATED IMAGE YES
MARK STATEMENT The mark consists of standard characters, without claim to any particular font style, size or color.
FORM TEXT
The undersigned respectfully requests to be removed as the domestic representative.

Please send all future correspondence to the undersigned at TESlonim@mintz.com
SIGNATURE SECTION
SUBMISSION SIGNATURE /Timur S. Slonim/
SIGNATORY'S NAME Timur S. Slonim
SIGNATORY'S POSITION Attorney of record
SIGNATORY'S PHONE NUMBER 2126926704
DATE SIGNED 11/10/2016
AUTHORIZED SIGNATORY YES
FILING INFORMATION SECTION
SUBMIT DATE Thu Nov 10 13:22:04 EST 2016
TEAS STAMP USPTO/WOD-XX.XX.XXX.X-201
61110132204277443-1769633
-20161110131328758020-N/A
-N/A-20161110131328758020



Under the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number.
PTO Form No Form Number (Rev 01/2012)
OMB No. 0651-0056 (Exp 09/30/2017)

Request to withdraw as Domestic Representative


To the Commissioner for Trademarks:


The following is submitted for registration number. 1769633 PYCNOGENOL

FORM INFORMATION

The undersigned respectfully requests to be removed as the domestic representative.

Please send all future correspondence to the undersigned at TESlonim@mintz.com


SIGNATURE(S)
Submission Signature
Signature: /Timur S. Slonim/     Date: 11/10/2016
Signatory's Name: Timur S. Slonim
Signatory's Position: Attorney of record
Signatory's Phone Number: 2126926704

        
Serial Number: 74022937
Internet Transmission Date: Thu Nov 10 13:22:04 EST 2016
TEAS Stamp: USPTO/WOD-XX.XX.XXX.X-201611101322042774
43-1769633-20161110131328758020-N/A-N/A-
20161110131328758020



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