APPLICATION FOR RENEWAL OF TRADEMARK/SERVICE MARK This application must be accompanied by a specimen showing actual use of the mark and the $50 filing fee for each classification claimed.

1. APPLICANT NAME

2. ADDRESS (NUMER & STREET) CITY STATE ZIP+4

3. NAME AND DESCRIPTION OF MARK TO BE RENEWED PURSUANT TO ARTICLE 24 OF THE GENERAL BUSINESS LAW

4. DATE THE MARK WAS REGISTERED WITH THE 5. ORIGINAL REGISTRATION NUMBER 6. SPECIFY TYPE TRADEMARK

SECRETARY OF STATE OF THE STATE OF NEW YORK OF MARKBEING RENEWED

SERVICE MARK

The above reference mark has been and still is in use.

(Signature of Applicant)

State of New York,

County of } ss:

I, , being duly sworn, depose and state that I am the person described in the foregoing application and that I have read the foregoing application and know the contents thereof to be true, except as to the matters therein stated to be alleged upon information and belief, and as to those matters, I believe them to be true.

(Name of Signer)

(Title of Signer)

Sworn to me this day

of , 20

X (Notary Public)

DOS-0247-f-l-a (Rev. 10/18) Page 1 of 1

DOS use only

Registration No.:

FOR OFFICE USE ONLY