| 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 |
2676657 |
| REGISTRATION DATE |
01/21/2003 |
| SERIAL NUMBER |
76257428 |
| MARK SECTION |
| MARK |
CHIP |
| ATTORNEY SECTION (current) |
| NAME |
A.J. Zottola |
| FIRM NAME |
VENABLE LLP |
| STREET |
575 7TH STREET, NW |
| CITY |
P.O. |
| STATE |
BOX |
| POSTAL CODE |
34385 |
| COUNTRY |
United States |
| PHONE |
202-344-8546 |
| FAX |
202-344-8300 |
| EMAIL |
ajzottola@venable.com |
| AUTHORIZED TO COMMUNICATE VIA E-MAIL |
Yes |
| ATTORNEY SECTION (proposed) |
| NAME |
Andrew Roppel |
| FIRM NAME |
Holland & Hart LLP |
| INTERNAL ADDRESS |
Attn. Trademark Docketing |
| STREET |
PO Box 8749 |
| CITY |
Denver |
| STATE |
Colorado |
| POSTAL CODE |
80201 |
| COUNTRY |
United States |
| PHONE |
303-473-2709 |
| FAX |
303-473-2720 |
| EMAIL |
docket@hollandhart.com |
| AUTHORIZED TO COMMUNICATE VIA E-MAIL |
Yes |
| DOCKET/REFERENCE NUMBER |
81369.0002 |
| OTHER APPOINTED ATTORNEY |
Scott S. Havlick; Wendy J. Pifher; Matthew D. Abell; Andrea L. Anderson, Ester Martín Maillaro; Larry H. Tronco; Jessie A. Neville; Anna
Miller; Nadya Bosch; Matt Horlacher; Amanda L. Swaim; Janet Shih Hajek; Kazuyo Morita; Darin L. Brown |
| CORRESPONDENCE SECTION (current) |
| NAME |
A.J. ZOTTOLA |
| FIRM NAME |
VENABLE LLP |
| STREET |
575 7TH STREET, NW |
| CITY |
P.O. |
| STATE |
BOX |
| POSTAL CODE |
34385 |
| COUNTRY |
United States |
| PHONE |
202-344-8546 |
| FAX |
202-344-8300 |
| EMAIL |
ajzottola@venable.com |
| AUTHORIZED TO COMMUNICATE VIA E-MAIL |
Yes |
| CORRESPONDENCE SECTION (proposed) |
| NAME |
Andrew Roppel |
| FIRM NAME |
Holland & Hart LLP |
| INTERNAL ADDRESS |
Attn. Trademark Docketing |
| STREET |
PO Box 8749 |
| CITY |
Denver |
| STATE |
Colorado |
| POSTAL CODE |
80201 |
| COUNTRY |
United States |
| PHONE |
303-473-2709 |
| FAX |
303-473-2720 |
| EMAIL |
docket@hollandhart.com |
| AUTHORIZED TO COMMUNICATE VIA E-MAIL |
Yes |
| DOCKET/REFERENCE NUMBER |
81369.0002 |
| GOODS AND/OR SERVICES SECTION |
| INTERNATIONAL CLASS |
042 |
| GOODS OR SERVICES |
HEALTH INFORMATION SERVICES, NAMELY, PROVIDING INFORMATION TO PREVENT, TREAT AND REVERSE, CORONARY HEART DISEASE AND ASSOCIATED DISEASES THROUGH
CHANGES IN LIFESTYLE |
| SPECIMEN FILE NAME(S) |
| ORIGINAL PDF FILE |
SPN0-6323611269-134136412_._specimen_-_website_excerpt.pdf |
CONVERTED PDF FILE(S)
(2 pages) |
\\TICRS\EXPORT16\IMAGEOUT16\762\574\76257428\xml1\S890002.JPG |
| |
\\TICRS\EXPORT16\IMAGEOUT16\762\574\76257428\xml1\S890003.JPG |
| SPECIMEN DESCRIPTION |
website excerpt |
| OWNER SECTION (current) |
| NAME |
LIFESTYLE MEDICINE INSTITUTE LLC |
| STREET |
1 SANITARIUM DRIVE |
| CITY |
BERKELY VALE N.S.W. |
| ZIP/POSTAL CODE |
2261 |
| COUNTRY |
Australia |
| LEGAL ENTITY SECTION (current) |
| TYPE |
limited liability company |
| STATE/COUNTRY WHERE LEGALLY ORGANIZED |
Delaware |
| LEGAL ENTITY SECTION (proposed) |
| TYPE |
limited liability company |
| STATE/COUNTRY WHERE LEGALLY ORGANIZED |
Delaware |
| PAYMENT SECTION |
| NUMBER OF CLASSES |
1 |
| NUMBER OF CLASSES PAID |
1 |
| SUBTOTAL AMOUNT |
500 |
| GRACE PERIOD |
200 |
| TOTAL FEE PAID |
700 |
| SIGNATURE SECTION |
| SIGNATURE |
/Andrew Roppel/ |
| SIGNATORY'S NAME |
Andrew Roppel |
| SIGNATORY'S POSITION |
Attorney for Registrant, Colorado bar member |
| DATE SIGNED |
07/19/2013 |
| SIGNATORY'S PHONE NUMBER |
303-473-2709 |
| PAYMENT METHOD |
CC |
| FILING INFORMATION |
| SUBMIT DATE |
Fri Jul 19 13:52:25 EDT 2013 |
| TEAS STAMP |
USPTO/S08N09-XX.XXX.XXX.X
X-20130719135225335403-26
76657-500e46065f75361322a
971819da0cead4c4d75b2a6b1
81a17dcbaf1dba6141-CC-108
-20130719134136412987 |
| 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: 2676657
REGISTRATION DATE: 01/21/2003
MARK: CHIP
The owner, LIFESTYLE MEDICINE INSTITUTE LLC, a limited liability company legally organized under the laws of Delaware, having an address of
1 SANITARIUM DRIVE
BERKELY VALE N.S.W., 2261
Australia
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 INFORMATION SERVICES, NAMELY, PROVIDING INFORMATION TO PREVENT, TREAT AND REVERSE, CORONARY HEART DISEASE AND ASSOCIATED DISEASES THROUGH CHANGES
IN LIFESTYLE ; 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) website excerpt.
Original PDF file:
SPN0-6323611269-134136412_._specimen_-_website_excerpt.pdf
Converted PDF file(s) (2 pages)
Specimen File1
Specimen File2
The registrant's current Attorney Information: A.J. Zottola of VENABLE LLP
575 7TH STREET, NW
P.O., BOX 34385
United States
The registrant's proposed Attorney Information: Andrew Roppel of Holland & Hart LLP
Attn. Trademark Docketing
PO Box 8749
Denver, Colorado (CO) 80201
United States
The docket/reference number is 81369.0002.
The Other Appointed Attorney(s): Scott S. Havlick; Wendy J. Pifher; Matthew D. Abell; Andrea L. Anderson, Ester Martín Maillaro; Larry H. Tronco; Jessie A. Neville; Anna Miller; Nadya Bosch; Matt
Horlacher; Amanda L. Swaim; Janet Shih Hajek; Kazuyo Morita; Darin L. Brown.
The phone number is 303-473-2709.
The fax number is 303-473-2720.
The email address is docket@hollandhart.com.
The registrant's current Correspondence Information: A.J. ZOTTOLA of VENABLE LLP
575 7TH STREET, NW
P.O., BOX 34385
United States
The registrant's proposed Correspondence Information: Andrew Roppel of Holland & Hart LLP
Attn. Trademark Docketing
PO Box 8749
Denver, Colorado (CO) 80201
United States
The docket/reference number is 81369.0002.
The phone number is 303-473-2709.
The fax number is 303-473-2720.
The email address is docket@hollandhart.com.
A fee payment in the amount of $700 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: /Andrew Roppel/ Date: 07/19/2013
Signatory's Name: Andrew Roppel
Signatory's Position: Attorney for Registrant, Colorado bar member
Signatory's Phone Number: 303-473-2709
Mailing Address
(current):
VENABLE LLP
575 7TH STREET, NW
P.O., BOX 34385
Mailing Address
(proposed):
Holland & Hart LLP
PO Box 8749
Denver, Colorado 80201
Serial Number: 76257428
Internet Transmission Date: Fri Jul 19 13:52:25 EDT 2013
TEAS Stamp: USPTO/S08N09-XX.XXX.XXX.XX-2013071913522
5335403-2676657-500e46065f75361322a97181
9da0cead4c4d75b2a6b181a17dcbaf1dba6141-C
C-108-20130719134136412987
