Mississippi Trademark Servicemark Assignment Form

In the case of a registered trademark or service mark in the State of Mississipi wanting to transfer its registered name to another entity, the following form has to be completed and submitted along with a $50 fee.

Extracted Text for Proper Search

F0024 - Page 1 of 2	 	
 OFFICE OF THE MISSISSIPPI SECRETARY OF STATE	
 
P.O. BOX 136, JACKSON, MS 39205-0136     (601) 359-1633	
 
  Trade and Service Mark Assignment 	
 
�	 	
1. Registration number 	      	
 	
2. The mark to be assigned is 	
�	 	      	
  
 	
3. ASSIGNOR: 	
 	
 Name 	
�	 	      	
�	 	Indicate if Assignor is a corporation or other entity 
and the State of incorporation or organization:  	
id	
 	Incorporated 	State 	 	
�	 	 	Organized 	State 	 	
 
 	
4. ASSIGNEE: 	
 	
 Name 	
�	 	      	
 �	 	Indicate if Assignee is a corporation or other entity 
and the State of incorporation or organization: 	 	Incorporated 	State 	 
   	
�	 	 	 	Organized 	State 	 
   	
 	 Address 	
 	 	
 	    City, State, ZIP5, ZIP4 	 	 	 	- 	 	
 	5. All right, title and interest in and to said mark, together with the good will of business in 
which the mark is used (or that part of the good will of the business connected with the use of 
the mark) is hereby assigned by 	
 �	 	 	(the Assignor) to 	
�	  	 	(the Assignee). 	
[F0024]   Rev. 10/08   	page 1 of 2

By: Signature of 	 (	Please keep writing within blocks)	 	
 	 Assignor  	
 	  	
 	   	
  	 Printed Name 
  Title 
 	
  	By: Signature of 	  (	Please keep writing within blocks)	 	
 	 Assignee  	
 	  	
 	    	
  	 Printed Name 
  Title 
 	
   
 ACKNOWLEDGMENT 
�	 	State of 	         	
�	 	County of 	         	
�	 	Sworn to and subscribed before me this 	           
day of  ,    	
 	
 	Notar	y 	  Notar	y	
 	Seal 	 Si	gnature	
 	 	 	
 	 	 	
 	 	 	
 	 	 	
�	 	My commission expires 	      	
 
INSTRUCTIONS: The above assignm
 ent must be signed by both the Assignor  and the Assignee. If either is a corporation or 
other entity, the name of the corporation or entity is to be  inserted as Assignor or Assignee with the signature of the proper 
authorities.   Please enclose Filing Fee of $50.00 made payable to the Mississippi Secr\
etary of State	
 and mail it to
P.O. Box 136 Jackson, Mississippi 39205-0136.