| PTO Form 1963 (Rev 5/2006) |
| OMB No. 0651-0055 (Exp 10/31/2008) |
Combined Declaration of Use In Commerce & Application For Renewal of Registration of A Mark Under Sections 8 & 9
The table below presents the data as entered.
Input Field
|
Entered
|
| REGISTRATION NUMBER |
1959633 |
| REGISTRATION DATE |
03/05/1996 |
| SERIAL NUMBER |
74510419 |
| MARK SECTION |
| MARK |
TRUFORM |
| OWNER SECTION (current) |
| NAME |
Surgical Appliance Industries, Inc. |
| STREET |
3960 Rosslyn Drive |
| CITY |
Cincinnati |
| STATE |
OH |
| ZIP/POSTAL CODE |
45209 |
| COUNTRY |
US |
| OWNER SECTION (proposed) |
| NAME |
Surgical Appliance Industries, Inc. |
| STREET |
3960 Rosslyn Drive |
| CITY |
Cincinnati |
| STATE |
OH |
| ZIP/POSTAL CODE |
45209 |
| COUNTRY |
US |
| PHONE |
1-800-888-0458 |
| GOODS AND/OR SERVICES SECTION |
| INTERNATIONAL CLASS |
010 |
| KEEP EXISTING GOODS AND/OR SERVICES |
YES |
| SPECIMEN FILE NAME(S) |
\\TICRS\EXPORT10\IMAGEOUT 10\745\104\74510419\xml1\ S890002.JPG |
| |
\\TICRS\EXPORT10\IMAGEOUT 10\745\104\74510419\xml1\ S890003.JPG |
| SPECIMEN DESCRIPTION |
Truform logo with and without man in circle. These are used on all catalogs, flyers, product packaging, print advertisements and appropriate garment labels. |
| PAYMENT SECTION |
| NUMBER OF CLASSES |
1 |
| NUMBER OF CLASSES PAID |
1 |
| SUBTOTAL AMOUNT |
500 |
| TOTAL AMOUNT |
500 |
| SIGNATURE SECTION |
| SIGNATURE |
/L. Thomas Applegate/ |
| SIGNATORY NAME |
L. Thomas Applegate |
| SIGNATORY DATE |
04/18/2005 |
| SIGNATORY POSITION |
President |
| FILING INFORMATION |
| SUBMIT DATE |
Mon Apr 18 08:45:49 EDT 2005 |
| TEAS STAMP |
USPTO/S08N09-XXXXXXXXXX-2
0050418084549859171-19596
33-2001a6d6a23c7d5ca40433
1ec193fdfd9-CC-1101-20050
418083910665021 |
| PTO Form 1963 (Rev 5/2006) |
| OMB No. 0651-0055 (Exp 10/31/2008) |
Combined Declaration of Use In Commerce & Application For Renewal of Registration of A Mark Under Sections 8 & 9
To the Commissioner for Trademarks:
REGISTRATION NUMBER: 1959633
REGISTRATION DATE: 03/05/1996
MARK: TRUFORM
The owner, Surgical Appliance Industries, Inc., residing at 3960 Rosslyn Drive , Cincinnati, OH US 45209, is using the mark in commerce on or in connection with the goods and /or services as
follows:
For International Class 010, the owner is using or is using through a related company or licensee the mark in commerce on or in connection with all goods and/or services listed in the existing
registration.
The owner is submitting one specimen for each class showing the mark as used in commerce on or in connection with any item in the class of listed goods and/or services , consisting of a(n) Truform
logo with and without man in circle. These are used on all catalogs, flyers, product packaging, print advertisements and appropriate garment labels. .
Specimen-1
Specimen-2
A fee payment in the amount of $500 will be submitted with the form, representing payment for 1 class(es), plus any additional grace period fee, if necessary.
Declaration
Section 8: Declaration of Use in Commerce
The owner is using or is using through a related company or licensee the mark in commerce on or in connection with the goods/services identified above, as evidenced by the attached specimen(s)
showing the mark as used in commerce.
Section 9: Application for Renewal
The registrant requests that the registration be renewed for the goods and/or services identified above.
The undersigned being hereby warned that willful false statements and the like are punishable by fine or imprisonment, or both, under 18 U.S.C. Section 1001, and that such willful false statements
and the like may jeopardize the validity of this document, declares that he/she is properly authorized to execute this document on behalf of the Owner; and all statements made of his/her own
knowledge are true and that all statements made on information and belief are believed to be true.
Signature: /L. Thomas Applegate/ Date: 04/18/2005
Signatory's Name: L. Thomas Applegate
Signatory's Position: President
RAM Sale Number: 1101
RAM Accounting Date: 04/18/2005
Serial Number: 74510419
Internet Transmission Date: Mon Apr 18 08:45:49 EDT 2005
TEAS Stamp: USPTO/S08N09-XXXXXXXXXX-2005041808454985
9171-1959633-2001a6d6a23c7d5ca404331ec19
3fdfd9-CC-1101-20050418083910665021
