Legal Application for Registration

LEGAL APPLICATION FOR REGISTRATION

This Legal Application for Registration (the Application) is submitted by Applicant Name: with Principal Address: to Registrar Name: on Application Date:

RECITALS

WHEREAS, Applicant seeks registration of certain identifying information, name, mark, or record as specified in this Application for the purpose of official recognition, recordation, or issuance of a registration certificate; and

WHEREAS, Registrar administers registration, recordation, and issuance processes and requires Applicant to provide the statements, attestations, and supporting documentation set forth in this Application; and

WHEREAS, Applicant represents that the information supplied herein is true and complete to the best of Applicant's knowledge and that Applicant is authorized to seek the requested registration.

NOW THEREFORE, in consideration of the mutual covenants and representations contained in this Application, Applicant submits this Application and agrees to the terms and certifications set forth below.

1. DEFINITIONS

For purposes of this Application: "Application" means this Legal Application for Registration; "Registrar" means the receiving authority identified above; "Applicant" means the individual or entity identified above submitting this Application. Terms not otherwise defined herein shall have their ordinary legal meaning.

2. APPLICATION INFORMATION

Entity Type: Individual Corporation Limited Liability Company Partnership Other

3. OWNERSHIP, CONTROL, AND BENEFICIAL INTEREST

Are any principals or owners foreign nationals or foreign-controlled? Yes No

4. REQUIRED ATTACHMENTS

The following documents are submitted in support of this Application and are incorporated by reference into this Application: certificate of formation or incorporation, proof of principal address, government-issued identification for principals, and any additional instruments specifically required for the registration requested. List additional attachments below.

5. FEES AND PAYMENT

Applicant acknowledges that acceptance of fees does not guarantee approval and that additional fees may be required for expedited review or supplemental filings.

6. DECLARATIONS AND CERTIFICATIONS

Applicant certifies, under penalty of perjury and consistent with applicable law, that the information contained in this Application and in any accompanying documentation is true, complete, and accurate. Applicant further certifies that Applicant has authority to submit this Application and to bind the entity identified herein.

I certify under penalty of perjury that the information is true and accurate.
I have the authority to execute this Application on behalf of the Applicant.
To the best of my knowledge, the registration sought does not infringe the rights of a third party.

7. REPRESENTATIONS, WARRANTIES AND INDEMNITY

Applicant represents and warrants that Applicant will indemnify, defend, and hold harmless Registrar and its agents from any claims, liabilities, losses, or expenses (including reasonable attorneys' fees) arising from: (a) any false or misleading statement in this Application; (b) any documentation submitted in support of this Application that is forged, altered, or fraudulent; or (c) Applicant's breach of any representation or covenant contained herein.

8. PROCESSING, RETENTION, AND USE OF INFORMATION

Applicant consents to the processing and retention of information provided with this Application by Registrar and acknowledges that such information may be used for verification, recordation, public indexing, or other lawful administrative purposes. Registrar reserves the right to verify information with third parties where permitted by law.

9. NOTICES

10. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Application shall be governed by and construed in accordance with the laws of Jurisdiction: without regard to conflict of laws principles. This Application constitutes the entire agreement between Applicant and Registrar with respect to the subject matter hereof and supersedes all prior agreements, understandings, and representations, whether written or oral. If any provision of this Application is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

11. AMENDMENT; WAIVER; COUNTERPARTS

This Application may be amended only by a written instrument executed by both Applicant and an authorized representative of Registrar. No waiver by either party of any breach of any provision of this Application shall be deemed a waiver of any subsequent breach. This Application may be executed in one or more counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

12. AUTHORIZED SIGNATORIES

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