PTO Form 1553 (Rev 9/2005)
`
`OMB No. 0651-0054 (Exp. 09/30/2011)
`
`Trademark/Service Mark Amendment to Allege Use
`(15 U.S.C. Section 1051(c))
`
`The table below presents the data as entered.
`
`Input Field
`
`SERIAL NUMBER
`
`LAW OFFICE ASSIGNED
`
`NOTICE OF ALLOWANCE
`
`EXTENSION OF USE
`
`REQUEST TO DIVIDE
`
`MARK SECTION
`
`STANDARD CHARACTERS
`
`USPTO-GENERATED IMAGE
`
`OWNER SECTION (no change)
`
`ATTORNEY SECTION (current)
`
`NAME
`
`FIRM NAME
`
`STREET
`
`CITY
`
`STATE
`
`POSTAL CODE
`
`COUNTRY
`
`PHONE
`
`FAX
`
`EMAIL
`
`Entered
`
`77277777
`
`LAW OFFICE 117
`
`NO
`
`NO
`
`NO
`
`NO
`
`NO
`
`Jason M. Drangel
`
`EPSTEIN DRANGEL BAZERMAN & JAMES, LLP
`
`60 E 42ND ST RM 820
`
`NEW YORK
`
`New York
`
`10165-0808
`
`United States
`
`212-292-5390
`
`212-292-5391
`
`mail@ipcounselors.com
`
`ATTORNEY DOCKET NUMBER
`
`2168-510
`
`ATTORNEY SECTION (proposed)
`
`NAME
`
`FIRM NAME
`
`STREET
`
`CITY
`
`STATE
`
`POSTAL CODE
`
`COUNTRY
`
`PHONE
`
`Jason M. Drangel
`
`EPSTEIN DRANGEL BAZERMAN & JAMES, LLP
`
`60 E 42ND ST RM 820
`
`NEW YORK
`
`New York
`
`10165-0808
`
`United States
`
`212-292-5390
`
`

`
`FAX
`
`EMAIL
`
`AUTHORIZED TO COMMUNICATE VIA E-MAIL
`
`ATTORNEY DOCKET NUMBER
`
`GOODS AND/OR SERVICES SECTION
`
`INTERNATIONAL CLASS
`
`CURRENT IDENTIFICATION
`
`GOODS OR SERVICES
`
`FIRST USE ANYWHERE DATE
`
`FIRST USE IN COMMERCE DATE
`
`SPECIMEN FILE NAME(S)
`
`SPECIMEN DESCRIPTION
`
`PAYMENT SECTION
`
`NUMBER OF CLASSES
`
`SUBTOTAL AMOUNT
`
`TOTAL AMOUNT
`
`SIGNATURE SECTION
`
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)ORIGINAL PDF FILE
`
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)CONVERTED PDF FILE(S)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(1 page)
`
`SIGNATORY'S NAME
`
`SIGNATORY'S POSITION
`
`FILING INFORMATION
`
`SUBMIT DATE
`
`TEAS STAMP
`
`212-292-5391
`
`mail@ipcounselors.com
`
`Yes
`
`2168-510
`
`003
`
`NON-MEDICATED TATTOO CLEANING SOLUTIONS
`
`KEEP ALL LISTED
`
`09/00/2007
`
`09/00/2007
`
`\\TICRS\EXPORT5\IMAGEOUT5 \772\777\77277777\xml3\AA
`U0002.JPG
`
`a specimen label showing use of the mark thereon
`
`1
`
`100
`
`100
`
`hsign_1607996147-122208219_._DOC121608mb.pdf
`
`\\TICRS\EXPORT5\IMAGEOUT5\772\777\77277777\xml3\AAU0003.JPG
`
`Mario Barth
`
`President
`
`Tue Dec 16 12:30:14 EST 2008
`
`USPTO/AAU-XXX.XX.XX.XXX-2
`0081216123014192052-77277
`777-4004f4037916552c7eca4
`14479951658aa9-CC-8123-20
`081216122208219984
`
`

`
`PTO Form 1553 (Rev 9/2005)
`
`OMB No. 0651-0054 (Exp. 09/30/2011)
`
`To the Commissioner for Trademarks:
`
`Trademark/Service Mark Amendment to Allege Use
`(15 U.S.C. Section 1051(c))
`
`

`
`
`
` HIGHLY COCENIRAIED
`
`
`
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`
`Declaration
`
`Applicant requests registration of the above-identified tmdeinarkfservice mark in the United States
`Patent and Trademark Office on the Principal Register established by the Act of.Iu1y 5, 1946 { l 5 U.S.C'.
`Section 1051 et scq.. as amended). Applicant is the owner of the mark sought to be registered. and is
`using the mark in commerce on or in connection with the goodsfservices identified above, as evidenced
`by the attached spec imcn.(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 100 I , and that such willful false statements and the like
`may _iG0]J£II‘dl?.$ 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 tiue and that
`all statements made on infonnation and belief are believed to be true.
`F
`
`Signature Seetio :
`
`Signatorg/‘s Nan1é:_____‘ flm___v_‘H
`Si.g11iatory’s Position:_Q if ‘:32 to ;;=.,._1 1'
`
`Datesigned:
`
`g'§’\~ U43’ ~62
`
`NOTE TO APPLICANT: When filed as part ofthe electronic form (i.e., scanned and attached as an
`image file), the signature page must include both the signature information and the boilerplate
`declaration language. Do not include the entire application, but do ensure that the boilerplate declaration
`language actually appears; a signature by1'Ls'eIfwilfna1' be acceptable. If, due to browser limitations, the
`boilerplate declaration language appears on a previous page when printed, you must "merge" the
`declaration and signature block onto a single page prior to signing, so that the one complete page can be
`scanned to create an acceptable image file. It is recommended that you copy-and-paste the entire text
`form into another document, manipulate the spacing there to move the declaration and signature section
`to a separate page, and then print this new version of the text than to send to the signatory.
`
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