| 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
The table below presents the data as entered.
Input Field
|
Entered
|
| REGISTRATION NUMBER |
2571109 |
| REGISTRATION DATE |
05/21/2002 |
| SERIAL NUMBER |
76165856 |
| MARK SECTION |
| MARK |
MAXIM HEALTH SYSTEMS |
| ATTORNEY SECTION (current) |
| NAME |
Andrew B. Katz |
| FIRM NAME |
BELLES KATZ LLC |
| STREET |
721 DRESHER ROAD, SUITE 1100 |
| CITY |
HORSHAM |
| STATE |
Pennsylvania |
| POSTAL CODE |
19044 |
| COUNTRY |
United States |
| PHONE |
215-658-1890 |
| FAX |
888-649-7733 |
| EMAIL |
akatz@belleskatz.com |
| AUTHORIZED TO COMMUNICATE VIA E-MAIL |
Yes |
| ATTORNEY SECTION (proposed) |
| NAME |
Andrew B. Katz |
| FIRM NAME |
BELLES KATZ LLC |
| STREET |
721 DRESHER ROAD, SUITE 1100 |
| CITY |
HORSHAM |
| STATE |
Pennsylvania |
| POSTAL CODE |
19044 |
| COUNTRY |
United States |
| PHONE |
215-658-1890 |
| FAX |
888-649-7733 |
| EMAIL |
akatz@belleskatz.com |
| AUTHORIZED TO COMMUNICATE VIA E-MAIL |
Yes |
| DOCKET/REFERENCE NUMBER |
MAX-334 |
| CORRESPONDENCE SECTION (current) |
| NAME |
ANDREW B. KATZ |
| FIRM NAME |
BELLES KATZ LLC |
| STREET |
721 DRESHER ROAD, SUITE 1100 |
| CITY |
HORSHAM |
| STATE |
Pennsylvania |
| POSTAL CODE |
19044 |
| COUNTRY |
United States |
| PHONE |
215-658-1890 |
| FAX |
888-649-7733 |
| EMAIL |
akatz@belleskatz.com |
| AUTHORIZED TO COMMUNICATE VIA E-MAIL |
Yes |
| CORRESPONDENCE SECTION (proposed) |
| NAME |
ANDREW B. KATZ |
| FIRM NAME |
BELLES KATZ LLC |
| STREET |
721 DRESHER ROAD, SUITE 1100 |
| CITY |
HORSHAM |
| STATE |
Pennsylvania |
| POSTAL CODE |
19044 |
| COUNTRY |
United States |
| PHONE |
215-658-1890 |
| FAX |
888-649-7733 |
| EMAIL |
akatz@belleskatz.com |
| AUTHORIZED TO COMMUNICATE VIA E-MAIL |
Yes |
| DOCKET/REFERENCE NUMBER |
MAX-334 |
| GOODS AND/OR SERVICES SECTION |
| INTERNATIONAL CLASS |
042 |
| GOODS OR SERVICES |
health care and wellness services, namely, delivering on site preventative health care and wellness services to institutions |
| SPECIMEN FILE NAME(S) |
\\TICRS\EXPORT11\IMAGEOUT 11\761\658\76165856\xml2\ S890002.JPG |
| SPECIMEN DESCRIPTION |
jpeg printout of applicant's website showing the mark prominently used in connection with the described services |
| OWNER SECTION (current) |
| NAME |
Maxim Healthcare Services, Inc. |
| STREET |
7227 Lee Deforest Drive |
| CITY |
Columbia |
| STATE |
Maryland |
| ZIP/POSTAL CODE |
21046 |
| COUNTRY |
United States |
| LEGAL ENTITY SECTION (current) |
| TYPE |
corporation |
| STATE/COUNTRY OF INCORPORATION |
Maryland |
| PAYMENT SECTION |
| NUMBER OF CLASSES |
1 |
| NUMBER OF CLASSES PAID |
1 |
| SUBTOTAL AMOUNT |
500 |
| TOTAL FEE PAID |
500 |
| SIGNATURE SECTION |
| SIGNATURE |
/Toni-Jean Lisa/ |
| SIGNATORY'S NAME |
Toni-Jean Lisa |
| SIGNATORY'S POSITION |
General Counsel |
| DATE SIGNED |
04/25/2012 |
| PAYMENT METHOD |
CC |
| FILING INFORMATION |
| SUBMIT DATE |
Wed Apr 25 14:23:26 EDT 2012 |
| TEAS STAMP |
USPTO/S08N09-XX.XX.X.XXX-
20120425142326236632-2571
109-4905f1bd38d3a4e6b2519
dc88149502df0-CC-731-2012
0424162323762572 |
| 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: 2571109
REGISTRATION DATE: 05/21/2002
MARK: MAXIM HEALTH SYSTEMS
The owner, Maxim Healthcare Services, Inc., a corporation of Maryland, having an address of
7227 Lee Deforest Drive
Columbia, Maryland 21046
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 042, 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: health care and wellness services, namely, delivering on site preventative health care and wellness services to institutions ; 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) jpeg printout of applicant's website showing
the mark prominently used in connection with the described services.
Specimen File1
The registrant's current Attorney Information: Andrew B. Katz of BELLES KATZ LLC
721 DRESHER ROAD, SUITE 1100
HORSHAM, Pennsylvania (PA) 19044
United States
The registrant's proposed Attorney Information: Andrew B. Katz of BELLES KATZ LLC
721 DRESHER ROAD, SUITE 1100
HORSHAM, Pennsylvania (PA) 19044
United States
The docket/reference number is MAX-334.
The phone number is 215-658-1890.
The fax number is 888-649-7733.
The email address is akatz@belleskatz.com.
The registrant's current Correspondence Information: ANDREW B. KATZ of BELLES KATZ LLC
721 DRESHER ROAD, SUITE 1100
HORSHAM, Pennsylvania (PA) 19044
United States
The registrant's proposed Correspondence Information: ANDREW B. KATZ of BELLES KATZ LLC
721 DRESHER ROAD, SUITE 1100
HORSHAM, Pennsylvania (PA) 19044
United States
The docket/reference number is MAX-334.
The phone number is 215-658-1890.
The fax number is 888-649-7733.
The email address is akatz@belleskatz.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: /Toni-Jean Lisa/ Date: 04/25/2012
Signatory's Name: Toni-Jean Lisa
Signatory's Position: General Counsel
Mailing Address
(current):
BELLES KATZ LLC
721 DRESHER ROAD, SUITE 1100
HORSHAM, Pennsylvania 19044
Mailing Address
(proposed):
BELLES KATZ LLC
721 DRESHER ROAD, SUITE 1100
HORSHAM, Pennsylvania 19044
Serial Number: 76165856
Internet Transmission Date: Wed Apr 25 14:23:26 EDT 2012
TEAS Stamp: USPTO/S08N09-XX.XX.X.XXX-201204251423262
36632-2571109-4905f1bd38d3a4e6b2519dc881
49502df0-CC-731-20120424162323762572
