| 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 | 90148796 |
| LAW OFFICE ASSIGNED | LAW OFFICE 106 |
| MARK SECTION | |
| MARK | LA28 (stylized and/or with design, see http://tmng-al.uspto.gov /resting2/api/img/9014879 6/large) |
| OWNER SECTION(current) | |
| NAME | UNITED STATES OLYMPIC AND PARALYMPIC COMMITTEE |
| MAILING ADDRESS | ONE OLYMPIC PLAZA |
| CITY | COLORADO SPRINGS |
| STATE | Colorado |
| STATE/COUNTRY/REGION/JURISDICTION/U.S. TERRITORY | United States |
| ZIP/POSTAL CODE | 80909 |
| ATTORNEY SECTION(current) | |
| NAME | Dana Jozefczyk |
| ATTORNEY BAR MEMBERSHIP NUMBER | XXX |
| YEAR OF ADMISSION | XXXX |
| U.S. STATE/ COMMONWEALTH/ TERRITORY | XX |
| FIRM NAME | UNITED STATES OLYMPIC COMMITTEE |
| INTERNAL ADDRESS | OFFICE OF THE GENERAL COUNSEL |
| STREET | ONE OLYMPIC PLAZA |
| CITY | COLORADO SPRINGS |
| STATE | Colorado |
| STATE/COUNTRY/REGION/JURISDICTION/U.S. TERRITORY | United States |
| POSTAL/ZIP CODE | 80909 |
| PHONE | 719-866-4115 |
| dana.jozefczyk@usopc.org | |
| CORRESPONDENCE SECTION(current) | |
| NAME | DANA JOZEFCZYK |
| PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE | dana.jozefczyk@usopc.org |
| SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES) | tmdocketdc@huntonAk.com; jglasser@huntonAK.com |
| 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 | UNITED STATES OLYMPIC AND PARALYMPIC COMMITTEE |
| MAILING ADDRESS | ONE OLYMPIC PLAZA |
| CITY | COLORADO SPRINGS |
| STATE | Colorado |
| STATE/COUNTRY/REGION/JURISDICTION/U.S. TERRITORY | United States |
| ZIP/POSTAL CODE | 80909 |
| XXXX | |
| ATTORNEY SECTION (proposed) | |
| STATEMENT TEXT | By submission of this request, the undersigned appoints the following new attorney, is newly appearing as the attorney, or updates the information of an existing attorney of record: |
| NAME | Dana Jozefczyk |
| ATTORNEY BAR MEMBERSHIP NUMBER | XXX |
| YEAR OF ADMISSION | XXXX |
| U.S. STATE/ COMMONWEALTH/ TERRITORY | XX |
| FIRM NAME | United States Olympic and Paralympics Committee |
| STREET | ONE OLYMPIC PLAZA |
| CITY | COLORADO SPRINGS |
| STATE | Colorado |
| STATE/COUNTRY/REGION/JURISDICTION/U.S. TERRITORY | United States |
| POSTAL/ZIP CODE | 80909 |
| PHONE | 719-866-4115 |
| dana.jozefczyk@usopc.org | |
| CORRESPONDENCE SECTION (proposed) | |
| NAME | Dana Jozefczyk |
| PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE | dana.jozefczyk@usopc.org |
| SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES) | tmdocketing@ballardspahr.com; GlasserJ@ballardspahr.com |
| SIGNATURE SECTION | |
| SIGNATURE | /Dana Jozefczyk/ |
| SIGNATORY NAME | Dana Jozefczyk |
| SIGNATORY DATE | 12/14/2020 |
| SIGNATORY POSITION | United States Olympic and Paralympic Committee, Associate General Counsel |
| SIGNATORY PHONE NUMBER | 719.866.4115 |
| AUTHORIZED SIGNATORY | YES |
| FILING INFORMATION SECTION | |
| SUBMIT DATE | Mon Dec 14 18:08:30 ET 2020 |
| TEAS STAMP | USPTO/CAR-XX.XXX.XX.XX-20 201214180830729865-889391 68-75076bcd64cc85d25e02a6 1e324d4dcc30d0e654cee9226 bf6ceb6f4861a9f-N/A-N/A-2 0201214180029397622 |
| 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) |