Kansas Servicemark Application Form

In the case of wanting to register a servicemark in the State of Kansas, the following form has to be completed and submitted along with a $40 filing fee.

Extracted Text for Proper Search

o	Filing fee	The filing fee for the application is 	$40	. 	
o	Payment	Please enclose a check or money order payable to the Secretary of State. Forms received 
without the appropriate fee will not be accepted for filing. Please do not send cash. 	NOTICE: 	 	
There is a $25 service fee for all checks returned by your financial institution. Also, to expedite 
processing, please do not use staples on your documents or to attach checks.	
o	Applicant information	Complete the applicant’s name and address. The applicant may be an individual, company, 
association, union, or other organization.	
o	Classification schedule	Specify both number and class designation for the mark. At least one classification is required. 
See attached regulation.	
o	Samples or specimens	Submit three different samples of the mark. From the U.S. Patent and Trademark Office: “A 
specimen for a mark used in connection with services must show the mark used in providing 
or advertising the services. For example, your specimen may be a sign, a brochure about the 
services, an advertisement for the services, a website, a business card, or stationery showing 
the mark. The specimen must show or contain some reference to the services, that is, it is 
not just a display of the mark itself.” The specimens must be flat and no longer than 8½ x 12 
inches. (ex: a label or photograph of packaging)	
o	Duration of filing	Unless earlier cancelled, a service mark has a term of five years from the date the application 
was filed with the Secretary of State.	
o	Additional information	Registration of the service mark with the Secretary of State is strictly optional. Kansas statutes 
expressly provide that registration does not affect the common law rights of others. Any right 
you might have to use a mark has been acquired through your use of the mark. If someone 
has prior use of the mark, registration will not give you any rights. Only your legal counsel can 
advise you about conflicting claims.	
k a n s a s	 s e c r e ta ry	 o f	 s tat e	
Service Mark Application
Instructions	
Kansas Office of the Secretary of State:
Memorial Hall, 1st Floor (785) 296-4564  
120 S.W. 10th Avenue   [email protected]
Topeka, KS 66612-1594 www.sos.ks.gov
SMA
58-02	
The following form 	must be complete	 and 	
accompanied by 	the correct filing fee	 or the 	
document will 	not	 be accepted for filing.	
Inst.	K.S.A. 81-204Rev. 05/09/11 jdr  	
Stay up-to-date on your trademark or service 
mark status, expiration date, and contact 
address at 	www.sos.ks.gov	.	
Please proceed to form.

1.  Applicant/owner name
2.  Applicant/owner 	address
Address will be used to send official mail from the Kansas Secretary of State’s Office. 
Do not leave blank.	
Attention Name
Address
City	State	Zip	Country	
3.  Is applicant a corporation, limited liability company, limited partnership, limited liability partnership, or other 	business entity, or is applicant a partnership?	
o 	 Corporation, LLC, LP, LLP, or other business entity (Proceed to Question 3a).	 o Partnership (Proceed to Question 3b).	
3a.  If applicant is a corporation, LLC, LP, LLP, or other business entity, give the state of organization.
3b.  If applicant is a partnership, give the state of organization and the names of the general partners.
4.  Briefly describe the services used in connection with the mark.
5.  Briefly describe how the mark is used in connection with such services.	
THIS SPACE FOR OFFICE USE ONLY.	
1 / 2	K.S.A. 81-204Rev. 05/09/11 jdr  	Please continue to next page.	
k a n s a s	 s e c r e ta ry	 o f	 s tat e	
Service Mark Application	
This form 	must be complete	 and accompanied by 	the correct 	
filing fee	 or the document will 	not	 be accepted for filing.	
Stay up-to-date on your trademark or service mark status, 
expiration date, and contact address at 	www.sos.ks.gov	.	
SMA
58-02

6.  Number(s) and class(es) of service(s)	
See classification schedule attached.	
7a.  Date applicant began 	use of service mark in Kansas	
Month	Day	Year	7b.  Date applicant began 	use of service mark anywhere	
Month	Day	Year	
8.  Has the applicant or predecessor in interest filed an application for the same mark or portions of the same mark 	with the U.S. Patent and Trademark Office?	
o 	 Yes (Proceed to Question 8a).	 o No (Skip to Question 9a).	
8a.  If yes, give the filing date and serial number.
8b.  What is the status of the application?	 o 	Accepted	 o Pending	 o Refused	
8c.  If refused, give reason.
9a.  Provide the name of the mark. This is how the mark will be searched with the Kansas Secretary of State’s office. 
9b.  Describe in words the exact mark you wish to register.
10.  Attach three different samples or specimens showing the mark as actively used.
11.  The applicant is the owner of the mark. The mark is in use, and, to the knowledge of the person verifying the 	application, no other person has registered, either federally or in this state, or has the right to use such mark either in the identical form thereof or in such near resemblance thereto as to be likely , when applied to the services of such other person, to cause confusion, or to cause mistake, or to deceive.	
12.  	 I state that I am the applicant, a member of the firm applying, or an officer of the corporation or association 
applying, and declare under penalty of perjury that the foregoing application is true and correct.	
Signature of Applicant / Owner
X	
Month	Day	Year	
Name of Applicant / Owner (printed or typed)
Phone Number
2 / 2	K.S.A. 81-204Rev. 05/09/11 jdr  	Please review to ensure completion.

Att. 	K.S.A. 81-204Rev. 05/09/11 jdr  	Use to respond to Question 6. 	
k a n s a s	 s e c r e ta ry	 o f	 s tat e	
Service Mark Application
Attachment	
Kansas Office of the Secretary of State:
Memorial Hall, 1st Floor (785) 296-4564  
120 S.W. 10th Avenue   [email protected]
Topeka, KS 66612-1594 www.sos.ks.gov
SMA
58-02
Class 35 (Advertising and business): 	Advertising; 	
business management; business administration; office 
functions.
Class 36 (Insurance and financial): 	Insurance; financial 	
affairs; monetary affairs; real estate affairs.
Class 37 (Building construction and repair): 	Building 	
construction; repair; installation services.
Class 38 (Telecommunications): 	Telecommunications.	
Class 39 (Transportation and storage): 	Transport; 	
packaging and storage of goods; travel arrangement.
Class 40 (Treatment of materials): 	Treatment of materials.	
Class 41 (Education and entertainment): 	Education; 	
providing of training; entertainment; sporting and cultural 
activities.	
Class 42 (Computer and scientific): 	Scientific and 	
technological services and research and design relating 
thereto; industrial analysis and research services; design and 
development of computer hardware and software.
Class 43 (Hotels and restaurants): 	Services for providing 	
food and drink; temporary accommodations.
Class 44 (Medical, beauty & agricultural): 	Medical 	
services; veterinary services; hygienic and beauty care 
for human beings or animals; agriculture, horticulture and 
forestry services.
Class 45 (Personal): 	Legal services; security services for 	
the protection of property and individuals; personal and 
social services rendered by others to meet the needs of 
individuals.	
n 	International Schedule of Classes of Services