Trademark/Service Mark Application, Principal Register
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 1478 (Rev 09/2006)
OMB No. 0651-0009 (Exp 02/28/2021)
Trademark/Service Mark Application, Principal Register
TEAS Plus Application
Serial Number:88786740
Filing Date:02/05/2020
NOTE: Data fields with the * are mandatory under TEAS Plus. The wording "(if applicable)" appears where the field is only mandatory under the facts of the particular
application.
The mark consists of standard characters, without claim to any particular font style, size, or color.
REGISTER
Principal
APPLICANT INFORMATION
*OWNER OF MARK
Laurel Lee Derby
*STREET
402 West 22nd St, Apt 2R
*CITY
NEW YORK
*STATE
(Required for U.S. applicants)
New York
*COUNTRY
United States
*ZIP/POSTAL CODE
(Required for U.S. and certain international addresses)
10011
PHONE
229-254-3624
EMAIL ADDRESS
laurel.derby@gmail.com
AUTHORIZED TO COMMUNICATE VIA EMAIL
Yes
LEGAL ENTITY INFORMATION
*TYPE
INDIVIDUAL
* COUNTRY OF CITIZENSHIP
United States
GOODS AND/OR SERVICES AND BASIS INFORMATION
*INTERNATIONAL CLASS
005
*IDENTIFICATION
Nutritional supplements for hydration
*FILING BASIS
SECTION 1(b)
ADDITIONAL STATEMENTS INFORMATION
*TRANSLATION
(if applicable)
*TRANSLITERATION
(if applicable)
*CLAIMED PRIOR REGISTRATION
(if applicable)
*CONSENT (NAME/LIKENESS)
(if applicable)
*CONCURRENT USE CLAIM
(if applicable)
CORRESPONDENCE INFORMATION
*NAME
Laurel Lee Derby
*STREET
402 West 22nd St, Apt 2R
*CITY
NEW YORK
*STATE
(Required for U.S. addresses)
New York
*COUNTRY
United States
*ZIP/POSTAL CODE
10011
PHONE
229-254-3624
*EMAIL ADDRESS
laurel.derby@gmail.com
*AUTHORIZED TO COMMUNICATE VIA EMAIL
Yes
FEE INFORMATION
APPLICATION FILING OPTION
TEAS Plus
NUMBER OF CLASSES
1
FEE PER CLASS
225
*TOTAL FEE PAID
225
SIGNATURE INFORMATION
* SIGNATURE
/Laurel Lee Derby/
* SIGNATORY'S NAME
Laurel Lee Derby
* SIGNATORY'S POSITION
Owner
SIGNATORY'S PHONE NUMBER
229-254-3624
* DATE SIGNED
02/05/2020
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 1478 (Rev 09/2006)
OMB No. 0651-0009 (Exp 02/28/2021)
Trademark/Service Mark Application, Principal Register
TEAS Plus Application
Serial Number:88786740
Filing Date:02/05/2020
To the Commissioner for Trademarks:
MARK: Holy Water (Standard Characters, see mark)
The literal element of the mark consists of Holy Water. The mark consists of standard characters, without claim to any particular font style, size, or color.
The applicant, Laurel Lee Derby, a citizen of United States, having an address of
402 West 22nd St, Apt 2R
NEW YORK, New York 10011
United States
229-254-3624(phone)
laurel.derby@gmail.com
requests registration of the trademark/service mark identified above in the United States Patent and Trademark Office on the Principal Register established by the Act of July 5, 1946 (15 U.S.C.
Section 1051 et seq.), as amended, for the following:
For specific filing basis information for each item, you must view the display within the Input Table.
International Class 005: Nutritional supplements for hydration
Intent to Use: The applicant has a bona fide intention, and is entitled, to use the mark in commerce on or in connection with the identified goods/services. (15 U.S.C. Section 1051(b)).
The applicant's current Correspondence Information:
Laurel Lee Derby
402 West 22nd St, Apt 2R
NEW YORK, New York 10011
229-254-3624(phone)
laurel.derby@gmail.com (authorized).
Email Authorization: I authorize the USPTO to send email correspondence concerning the application to the applicant or the applicant's attorney, or the applicant's domestic representative at
the email address provided in this application. I understand that a valid email address must be maintained and that the applicant or the applicant's attorney must file the relevant subsequent
application-related submissions via the Trademark Electronic Application System (TEAS). Failure to do so will result in the loss of TEAS Plus status and a requirement to submit an additional
processing fee of $125 per international class of goods/services.
A fee payment in the amount of $225 has been submitted with the application, representing payment for 1 class(es).
Declaration
Declaration Signature
Signature: /Laurel Lee Derby/ Date: 02/05/2020
Signatory's Name: Laurel Lee Derby
Signatory's Position: Owner
Signatory's Phone Number: 229-254-3624
Payment Sale Number: 88786740
Payment Accounting Date: 02/05/2020
Serial Number: 88786740
Internet Transmission Date: Wed Feb 05 23:23:20 EST 2020
TEAS Stamp: USPTO/FTK-XXXX:XXXX:XXXX:XXXX:XXXX:XXXX:
XXXX:XXXX-20200205232320632132-88786740-
700174daed4578342aa711b76d7f9ba3c3a1885f
7dbdf52f3845e73de29c4270-CC-23191628-202
00205230256457467