| 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) |
| Input Field | Entered |
|---|---|
| SERIAL NUMBER | 87975404 |
| REGISTRATION NUMBER | 5262712 |
| LAW OFFICE ASSIGNED | LAW OFFICE 107 |
| MARK SECTION | |
| MARK | QURE (standard characters, see http://tmng-al.uspto.gov /resting2/api/img/8797540 4/large) |
| OWNER SECTION(current) | |
| NAME | Cleanse and Burn, Inc. |
| MAILING ADDRESS | 2901 West Coast Hwy Suite 200 |
| CITY | Newport Beach |
| STATE | California |
| STATE/COUNTRY/REGION/JURISDICTION/U.S. TERRITORY | United States |
| ZIP/POSTAL CODE | 92663 |
| PHONE | 310.800.6828 |
| FAX | 949.891.0592 |
| XXXX | |
| ATTORNEY SECTION(current) | |
| STATEMENT TEXT | By submission of this request, the undersigned REVOKES the power of attorney currently of record, as listed below: |
| NAME | Oliver P. Baclay, Jr. |
| ATTORNEY BAR MEMBERSHIP NUMBER | NOT SPECIFIED |
| YEAR OF ADMISSION | NOT SPECIFIED |
| U.S. STATE/ COMMONWEALTH/ TERRITORY | NOT SPECIFIED |
| FIRM NAME | Gulapa & Baclay LLP |
| INTERNAL ADDRESS | 12th Floor, 1115 Broadway |
| STREET | 12th Floor, 1115 Broadway |
| CITY | New York |
| STATE | New York |
| STATE/COUNTRY/REGION/JURISDICTION/U.S. TERRITORY | United States |
| POSTAL/ZIP CODE | 10010 |
| PHONE | 18622022212 |
| oliver.baclay@gulapalaw.com | |
| CORRESPONDENCE SECTION(current) | |
| NAME | Oliver P. Baclay, Jr. |
| PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE | oliver.baclay@gulapalaw.com |
| SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES) | NOT PROVIDED |
| OWNER SECTION(proposed) | |
| STATEMENT TEXT |
By submission of this request, the undersigned requests that the following be made of record for the owner/holder: |
| NAME | Cleanse and Burn, Inc. |
| MAILING ADDRESS | 333 City Blvd. West Ste 1700 |
| CITY | Orange |
| STATE | California |
| STATE/COUNTRY/REGION/JURISDICTION/U.S. TERRITORY | United States |
| ZIP/POSTAL CODE | 92868 |
| PHONE | 310.800.6828 |
| FAX | 949.891.0592 |
| XXXX | |
| CORRESPONDENCE SECTION (proposed) | |
| NAME | Cleanse and Burn, Inc. |
| PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE | tventura@qurewater.com |
| SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES) | lesley@qurewater.com |
| SIGNATURE SECTION | |
| SIGNATURE | /Thomas Ventura/ |
| SIGNATORY NAME | Thomas Ventura |
| SIGNATORY DATE | 05/31/2020 |
| SIGNATORY POSITION | Owner |
| SIGNATORY PHONE NUMBER | 310-800-6828 |
| AUTHORIZED SIGNATORY | YES |
| FILING INFORMATION SECTION | |
| SUBMIT DATE | Sun May 31 23:59:30 ET 2020 |
| TEAS STAMP | USPTO/CAR-XX.XXX.XX.X-202 00531235930399495-8797540 4-710d3332004b11493d83a06 426c51d53d4ce4852cce5dbee e9b66e3fccc47af1-N/A-N/A- 20200531235612078374 |
| 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) |