| PTO Form 2197 (Rev 09/2005) |
| OMB No. 0651-0056 (Exp 09/30/2011) |
| Input Field | Entered |
|---|---|
| SERIAL NUMBER | 76345509 |
| REGISTRATION NUMBER | 2618147 |
| LAW OFFICE ASSIGNED | LAW OFFICE 109 |
| MARK SECTION | |
| MARK | 1-800-SMOKING |
| OWNER SECTION (current) | |
| NAME | Pinzon, Brian W. |
| STREET | 1751 High Point Circle |
| CITY | Black Hawk |
| STATE | Colorado |
| ZIP/POSTAL CODE | 80422 |
| COUNTRY | US |
| PHONE | 303-582-3064 |
| CORRESPONDENCE SECTION (current) | |
| ORIGINAL ADDRESS | Tish Masslich 1751 High Point circle 1751 High Point Circle Black Hawk Colorado 80422 United States 303-582-3064 303-582-3064 bpinzon@elp.rr.com |
| NEW OWNER ADDRESS | |
| STREET | 1751 Highpoint Cir |
| CITY | Black Hawk |
| STATE | Colorado |
| ZIP/POSTAL CODE | 80422 |
| COUNTRY | United States |
| NEW CORRESPONDENCE ADDRESS FOR OWNER | |
| NAME | Tish Masslich |
| STREET | 1751 High Point Circle |
| CITY | Black Hawk |
| STATE | Colorado |
| COUNTRY | United States |
| POSTAL/ZIP CODE | 80422 |
| PHONE | 303-995-6544 |
| FAX | 703-461-2898 |
| SIGNATURE SECTION | |
| SIGNATURE | /Tish Masslich/ |
| SIGNATORY NAME | Tish Masslich |
| SIGNATORY DATE | 01/12/2010 |
| SIGNATORY POSITION | Owner |
| FILING INFORMATION SECTION | |
| SUBMIT DATE | Tue Jan 12 22:40:27 EST 2010 |
| TEAS STAMP | USPTO/COA-XX.XXX.XXX.XXX- 20100112224027153025-7634 5509-46089d71afaea49a824a bfb357337455ce0-N/A-N/A-2 0100112222221507180 |