PR-Section 8 and 9

PTO Form 1963 (Rev 5/2006)

OMB No. 0651-0055 (Exp 07/31/2018)

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PTO Form 1963 (Rev 5/2006)

OMB No. 0651-0055 (Exp 07/31/2018)

Combined Declaration of Use and/or Excusable Nonuse/Application for Renewal of Registration of a Mark under Sections 8 & 9

To the Commissioner for Trademarks:

REGISTRATION NUMBER: 2611825
REGISTRATION DATE: 08/27/2002

MARK: POLY HIST FORTE

The owner, Poly Pharmaceuticals, Inc., a corporation of Alabama, having an address of
      P. O. Box 93
      Quitman, Mississippi 39355
      United States
is filing a Combined Declaration of Use and/or Excusable Nonuse/Application for Renewal of Registration of a Mark under Sections 8 & 9.

For International Class 005, the mark is in use in commerce on or in connection with all goods/services, or to indicate membership in the collective membership organization, listed in the existing registration for this specific class: PHARMACEUTICAL PREPARATIONS INDICATED FOR ANTIHISTAMINE AND DECONGESTANT USES ; or, the owner is making the listed excusable nonuse claim.

The owner is submitting one(or more) specimen(s) showing the mark as used in commerce on or in connection with any item in this class, consisting of a(n) product label.
Specimen File1
The registrant's current Attorney Information: William J Skinner of  POLY PHARMACEUTICALS INC
      200 N ARCHUSA AVE
      QUITMAN, Mississippi (MS) 39355
      United States


The registrant's proposed Attorney Information: Timothy A. Bush, Esq. of  SIROTE & PERMUTT, P.C.
      2311 HIGHLAND AVE. S.
      BIRMINGHAM, Alabama (AL) 35205
      United States



The phone number is 205.930.5282.

The fax number is 205.930.5101.

The email address is tbush@sirote.com.
The registrant's current Correspondence Information: JAMES H BROWNLEE of  POLY PHARMACEUTICALS INC
      200 N ARCHUSA AVE
      QUITMAN, Mississippi (MS) 39355
      United States


The registrant's proposed Correspondence Information: Timothy A. Bush, Esq. of  SIROTE & PERMUTT, P.C.
      2311 HIGHLAND AVE. S.
      BIRMINGHAM, Alabama (AL) 35205
      United States
The docket/reference number is 56883-1.


The phone number is 205.930.5282.

The fax number is 205.930.5101.

The email address is tbush@sirote.com;tmcclain@sirote.com.

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 and/or Excusable Nonuse in Commerce
Unless the owner has specifically claimed excusable nonuse, the mark is in use in commerce on or in connection with the goods and/or services identified above, as evidenced by the attached specimen(s) showing the mark as used in commerce.


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.

Section 9: Application for Renewal
The registrant requests that the registration be renewed for the goods/services/collective organization identified above.


Signature: /Zeb Baucum/      Date: 12/13/2011
Signatory's Name: Zeb Baucum
Signatory's Position: President
Signatory's Phone Number: 601.776.3497

Mailing Address (current):
   POLY PHARMACEUTICALS INC
   200 N ARCHUSA AVE
   QUITMAN, Mississippi 39355

Mailing Address (proposed):
   SIROTE & PERMUTT, P.C.
   2311 HIGHLAND AVE. S.
   BIRMINGHAM, Alabama 35205

Serial Number: 76157717
Internet Transmission Date: Wed Dec 14 15:51:25 EST 2011
TEAS Stamp: USPTO/S08N09-XX.XXX.XXX.XXX-201112141551
25666955-2611825-49046ad3291679ad2a54ad9
fcf57d53b10-DA-2736-20111213101917633088