| PTO Form 1553 (Rev 5/2006) |
| OMB No. 0651-0055 (Exp 12/31/2011) |
Declaration of Use and/or Excusable Nonuse of Mark in Commerce under Section 8
The table below presents the data as entered.
Input Field
|
Entered
|
| REGISTRATION NUMBER |
2855572 |
| REGISTRATION DATE |
06/22/2004 |
| SERIAL NUMBER |
76450196 |
| MARK SECTION |
| MARK |
MIAS |
| OWNER SECTION (current) |
| NAME |
Kunz, Peter F. |
| STREET |
3940 West 96th Street |
| CITY |
Indianapolis |
| STATE |
Indiana |
| ZIP/POSTAL CODE |
46268 |
| COUNTRY |
United States |
| OWNER SECTION (proposed) |
| NAME |
Kunz, Peter F. |
| STREET |
11725 Illinois Street Suite 270 |
| CITY |
Carmel |
| STATE |
Indiana |
| ZIP/POSTAL CODE |
46032 |
| COUNTRY |
United States |
| EMAIL |
XXXX |
| AUTHORIZED TO COMMUNICATE VIA E-MAIL |
Yes |
| GOODS AND/OR SERVICES SECTION |
| INTERNATIONAL CLASS |
044 |
| GOODS OR SERVICES |
KEEP ALL LISTED |
| SPECIMEN FILE NAME(S) |
\\TICRS\EXPORT10\IMAGEOUT 10\764\501\76450196\xml1\ S080002.JPG |
| SPECIMEN DESCRIPTION |
Our logo and name for the business. |
| PAYMENT SECTION |
| NUMBER OF CLASSES |
1 |
| NUMBER OF CLASSES PAID |
1 |
| SUBTOTAL AMOUNT |
100 |
| TOTAL FEE PAID |
100 |
| SIGNATURE SECTION |
| SIGNATURE |
/PFKunz/ |
| SIGNATORY'S NAME |
Peter F. Kunz, M.D. |
| SIGNATORY'S POSITION |
Owner |
| DATE SIGNED |
05/24/2010 |
| PAYMENT METHOD |
CC |
| FILING INFORMATION |
| SUBMIT DATE |
Mon May 24 13:13:48 EDT 2010 |
| TEAS STAMP |
USPTO/SECT08-XX.XXX.XXX.X
X-20100524131348180825-28
55572-460fb6410ddd6b5abab
5b6d9c77bcd590f1-CC-10939
-20100520160015750899 |
| PTO Form 1553 (Rev 5/2006) |
| OMB No. 0651-0055 (Exp 12/31/2011) |
Declaration of Use and/or Excusable Nonuse of Mark in Commerce under Section 8
To the Commissioner for Trademarks:
REGISTRATION NUMBER: 2855572
REGISTRATION DATE: 06/22/2004
MARK: MIAS
The owner, Kunz, Peter F., having an address of
11725 Illinois Street Suite 270
Carmel, Indiana 46032
United States
is filing a Declaration of Use and/or Excusable Nonuse of Mark in Commerce under Section 8.
For International Class 044, the mark is in use in commerce on or in connection with
all goods or services listed in the existing registration for this specific class; or, the owner is making
the listed excusable nonuse claim.
The owner is submitting one specimen showing the mark as used in commerce on or in connection with any item in this class, consisting of a(n) Our logo and name for the business..
Specimen File1
A fee payment in the amount of $100 will be submitted with the form, representing payment for 1 class(es), plus any additional grace period fee, if necessary.
Declaration
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.
Signature: /PFKunz/ Date: 05/24/2010
Signatory's Name: Peter F. Kunz, M.D.
Signatory's Position: Owner
Serial Number: 76450196
Internet Transmission Date: Mon May 24 13:13:48 EDT 2010
TEAS Stamp: USPTO/SECT08-XX.XXX.XXX.XX-2010052413134
8180825-2855572-460fb6410ddd6b5abab5b6d9
c77bcd590f1-CC-10939-2010052016001575089
9
