Change Address or Representation Form

KEYSTONE

Keystone Insurers Group, Inc.

Change Address or Representation Form

Under the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number.
PTO Form 2300 (Rev 02/2020)
OMB No. 0651-0051 (Exp 11/30/2020)

Change Address or Representation Form


The table below presents the data as entered.

Input Field Entered
SERIAL NUMBER 86955999
REGISTRATION NUMBER 5125825
LAW OFFICE ASSIGNED LAW OFFICE 109
MARK SECTION
MARK KEYSTONE (stylized and/or with design, see http://tmng-al.uspto.gov /resting2/api/img/8695599 9/large)
ATTORNEY SECTION(current)
NAME Steven W. Zoffer
ATTORNEY BAR MEMBERSHIP NUMBER NOT SPECIFIED
YEAR OF ADMISSION NOT SPECIFIED
U.S. STATE/ COMMONWEALTH/ TERRITORY NOT SPECIFIED
FIRM NAME Dickie McCamey & Chilcote, PC
INTERNAL ADDRESS Suite 400
STREET 2 PPG Place
CITY Pittsburgh
STATE Pennsylvania
STATE/COUNTRY/REGION/JURISDICTION/U.S. TERRITORY United States
POSTAL/ZIP CODE 15222
PHONE 4122817272
EMAIL szoffer@dmclaw.com
CORRESPONDENCE SECTION(current)
NAME Steven W. Zoffer
PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE szoffer@dmclaw.com
SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES) jyu@dmclaw.com; smickens@dmclaw.com; llasich@dmclaw.com; awaldinger@dmclaw.com
ATTORNEY SECTION (proposed)
STATEMENT TEXT By submission of this request, the undersigned REVOKES the power of attorney currently of record, as listed above, and hereby APPOINTS the following new attorney:
NAME Matthew J. Curran
ATTORNEY BAR MEMBERSHIP NUMBER XXX
YEAR OF ADMISSION XXXX
U.S. STATE/ COMMONWEALTH/ TERRITORY XX
FIRM NAME Penwell Bowman + Curran LLC
OTHER APPOINTED ATTORNEY(S) Brandt T. Bowman and Scott C. Penwell
STREET 215 Pine St., Ste. 200
CITY Harrisburg
STATE Pennsylvania
STATE/COUNTRY/REGION/JURISDICTION/U.S. TERRITORY United States
POSTAL/ZIP CODE 17101
PHONE 7177270570
EMAIL mcurran@penwelllaw.com
CORRESPONDENCE SECTION (proposed)
NAME Matthew J. Curran
PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE mcurran@penwelllaw.com
SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES) bbowman@penwelllaw.com; spenwell@penwelllaw.com; admin@penwelllaw.com
SIGNATURE SECTION
SIGNATURE /Mike Azar/
SIGNATORY NAME Mike Azar
SIGNATORY DATE 10/06/2020
SIGNATORY POSITION Chief Financial Officer
SIGNATORY PHONE NUMBER 5704732800
AUTHORIZED SIGNATORY YES
FILING INFORMATION SECTION
SUBMIT DATE Tue Oct 06 16:17:45 ET 2020
TEAS STAMP USPTO/CAR-XXX.XXX.XX.XXX-
20201006161745022336-7711
1732-750f45f9e7c9094e8533
5e4347838f0b5eb47c7d6636d
62f595cddbf040ee65d3f4-N/
A-N/A-2020100615500616741
2



Under the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number.
PTO Form 2300 (Rev 02/2020)
OMB No. 0651-0051 (Exp 11/30/2020)


Change Address or Representation Form


To the Commissioner for Trademarks:

MARK: KEYSTONE (stylized and/or with design, see http://tmng-al.uspto.gov /resting2/api/img/8695599 9/large)
SERIAL NUMBER: 86955999
REGISTRATION NUMBER: 5125825

Attorney Section (Current):
Steven W. Zoffer of Dickie McCamey & Chilcote, PC
is located at
Suite 400
2 PPG Place
Pittsburgh, Pennsylvania 15222
United States
4122817272
Email Address: szoffer@dmclaw.com

Correspondence Section (Current):
Steven W. Zoffer
PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE: szoffer@dmclaw.com
SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES): jyu@dmclaw.com; smickens@dmclaw.com; llasich@dmclaw.com; awaldinger@dmclaw.com


By submission of this request, the undersigned REVOKES the power of attorney currently of record, as listed above, and hereby APPOINTS the following new attorney:

Attorney Section (proposed):
Matthew J. Curran of Penwell Bowman + Curran LLC
XX bar, admitted in XXXX, bar membership no. XXX, is located at
215 Pine St., Ste. 200
Harrisburg, Pennsylvania 17101
United States
7177270570
mcurran@penwelllaw.com
Other Appointed Attorney(s): Brandt T. Bowman and Scott C. Penwell
Matthew J. Curran submitted the following statement: The attorney of record is an active member in good standing of the bar of the highest court of a U.S. state, the District of Columbia, or any U.S. Commonwealth or territory.
Correspondence Section (proposed):
Matthew J. Curran
PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE: mcurran@penwelllaw.com
SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES): bbowman@penwelllaw.com; spenwell@penwelllaw.com; admin@penwelllaw.com




Signature: /Mike Azar/      Date: 10/06/2020
Signatory's Name: Mike Azar
Signatory's Position: Chief Financial Officer
Signatory's Phone Number: 5704732800

Serial Number: 86955999
Internet Transmission Date: Tue Oct 06 16:17:45 ET 2020
TEAS Stamp: USPTO/CAR-XXX.XXX.XX.XXX-202010061617450
22336-77111732-750f45f9e7c9094e85335e434
7838f0b5eb47c7d6636d62f595cddbf040ee65d3
f4-N/A-N/A-20201006155006167412



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