| 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 |
2031295 |
| REGISTRATION DATE |
01/14/1997 |
| SERIAL NUMBER |
74682390 |
| MARK SECTION |
| MARK |
EMERGENCY PHYSICIANS BILLING SERVICES |
| OWNER SECTION (current) |
| NAME |
MEDICAL CONSULTANTS, INC. |
| STREET |
P.O. Box 96408, South East Station |
| CITY |
Oklahoma City |
| STATE |
OK |
| ZIP/POSTAL CODE |
73143 |
| COUNTRY |
US |
| OWNER SECTION (proposed) |
| NAME |
MEDICAL CONSULTANTS, INC. |
| STREET |
P.O. Box 96408, South East Station |
| CITY |
Oklahoma City |
| STATE |
Oklahoma |
| ZIP/POSTAL CODE |
73143 |
| COUNTRY |
United States |
| EMAIL |
XXXX |
| ATTORNEY SECTION |
| NAME |
Glen M. Burdick |
| FIRM NAME |
DUNLAP CODDING & ROGERS, P.C. |
| STREET |
P.O. Box 16370 |
| CITY |
Oklahoma City |
| STATE |
Oklahoma |
| ZIP/POSTAL CODE |
73113 |
| COUNTRY |
United States |
| PHONE |
405-607-8600 |
| FAX |
405-607-8686 |
| EMAIL |
mike_burdick@okpatents.com |
| AUTHORIZED TO COMMUNICATE VIA E-MAIL |
Yes |
| DOCKET NUMBERS |
2875.004 |
| OTHER APPOINTED ATTORNEY(S) |
30589 |
| GOODS AND/OR SERVICES SECTION |
| INTERNATIONAL CLASS |
035 |
| KEEP EXISTING GOODS AND/OR SERVICES |
YES |
| SPECIMEN FILE NAME(S) |
\\TICRS\EXPORT3\IMAGEOUT3 \746\823\74682390\xml1\S8 90002.JPG |
| SPECIMEN DESCRIPTION |
Letterhead |
| PAYMENT SECTION |
| NUMBER OF CLASSES |
1 |
| NUMBER OF CLASSES PAID |
1 |
| SUBTOTAL AMOUNT |
500 |
| TOTAL AMOUNT |
500 |
| SIGNATURE SECTION |
| SIGNATURE |
/glenmburdick/ |
| SIGNATORY NAME |
Glen M. Burdick |
| SIGNATORY DATE |
08/23/2006 |
| SIGNATORY POSITION |
Attorney for Applicant |
| PAYMENT METHOD |
CC |
| FILING INFORMATION |
| SUBMIT DATE |
Wed Aug 23 16:55:11 EDT 2006 |
| TEAS STAMP |
USPTO/S08N09-XXXXXXXXXX-2
0060823165511631477-20312
95-20015aa29c87023f98b3aa
20672638baae-CC-446-20060
823165048235482 |
| 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: 2031295
REGISTRATION DATE: 01/14/1997
MARK: EMERGENCY PHYSICIANS BILLING SERVICES
The owner, MEDICAL CONSULTANTS, INC., residing at P.O. Box 96408, South East Station, Oklahoma City, Oklahoma United States 73143, is using the mark in commerce on or in connection with the goods and
/or services as follows:
For International Class 035, 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)
Letterhead.
Specimen-1
The registrant hereby appoints Glen M. Burdick and 30589 of DUNLAP CODDING & ROGERS, P.C., P.O. Box 16370, Oklahoma City, Oklahoma United States 73113 to submit this Combined Declaration of
Use In Commerce & Application For Renewal of Registration of A Mark Under Sections 8 & 9 on behalf of the registrant. The attorney docket/reference number is 2875.004.
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: /glenmburdick/ Date: 08/23/2006
Signatory's Name: Glen M. Burdick
Signatory's Position: Attorney for Applicant
Mailing Address:
DUNLAP CODDING & ROGERS, P.C.
P.O. Box 16370
Oklahoma City, Oklahoma 73113
RAM Sale Number: 446
RAM Accounting Date: 08/24/2006
Serial Number: 74682390
Internet Transmission Date: Wed Aug 23 16:55:11 EDT 2006
TEAS Stamp: USPTO/S08N09-XXXXXXXXXX-2006082316551163
1477-2031295-20015aa29c87023f98b3aa20672
638baae-CC-446-20060823165048235482
