PTO Form 1553 (Rev 9/2005)
`
`OMB No. 0651-0054 (Exp. 10/31/2017)
`
`Trademark/Service Mark Request to Divide
`
`The table below presents the data as entered.
`
`Input Field
`
`Entered
`
`SERIAL NUMBER
`
`77753015
`
`LAW OFFICE ASSIGNED
`
`LAW OFFICE 105
`
`EXTENSION OF USE
`
`MARK SECTION
`
`MARK
`
`REQUEST TO DIVIDE
`
`GOOD(S)/SERVICE(S) IN USE
`
`YES
`
`OCTAGON GIRL
`
`YES
`
`All goods in Class 016; online retail store featuring clothing, calendars,
`greeting cards, trading cards, and other mixed martial arts merchandise;
`promoting the night club and party services of others and modeling for
`marketing and sales promotion (Class 035); all services in Class 041
`
`GOOD(S)/SERVICES INTENT TO USE
`
`Class 025
`
`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
`
`REQUEST TO DIVIDE SIGNATURE
`
`SIGNATORY'S NAME
`
`SIGNATORY'S POSITION
`
`DATE SIGNED
`
`AUTHORIZED SIGNATORY
`
`PAYMENT SECTION
`
`NUMBER OF CLASSES IN USE
`
`SUBTOTAL AMOUNT [ALLEGATION OF USE
`FEE]
`
`REQUEST TO DIVIDE FEE
`
`TOTAL AMOUNT
`
`PAYMENT METHOD
`
`FILING INFORMATION
`
`SUBMIT DATE
`
`TEAS STAMP
`
`hw_1744713130-120034707_._OCTAGON_GIRLS_SOU-Req_to_Div.pdf
`
`\\TICRS\EXPORT16\IMAGEOUT16\777\530\77753015\xml8\RTD0002.JPG
`
`Timothy J. Bellamy
`
`Senior Vice President and Associate General Counsel
`
`/Jennifer Ko Craft/
`
`Jennifer Ko Craft
`
`Attorney of Record, Nevada Bar Member
`
`06/24/2013
`
`YES
`
`3
`
`300
`
`100
`
`400
`
`CC
`
`Tue Jun 25 12:04:40 EDT 2013
`
`USPTO/SOU-XXX.XX.XX.XXX-2
`0130625120440147904-77753
`015-50081c681baa86e39b047
`ac66c1d8fd6d8670a2b8fce29
`
`

`

`432cd4eb07d507340d692-CC-
`13014-2013062512003470705
`8
`
`432cd4eb07d507340d692-CC-
`13014-2013062512003470705
`8
`
`

`

`PTO Form 1553 (Rev 9/2005)
`
`OMB No. 0651-0054 (Exp. 10/31/2017)
`
`To the Commissioner for Trademarks:
`
`MARK:(cid:160)OCTAGON GIRL
`SERIAL NUMBER:(cid:160)77753015
`
`Trademark/Service Mark Request to Divide
`
`REQUEST TO DIVIDE
`The applicant is requesting to divide the application and specifies the following:
`The following good(s) or service(s) is/are now in use: All goods in Class 016; online retail store featuring clothing, calendars, greeting cards,
`trading cards, and other mixed martial arts merchandise; promoting the night club and party services of others and modeling for marketing and
`sales promotion (Class 035); all services in Class 041
`The following good(s) or service(s) remain(s) under the Section 1(b), intent to use basis: Class 025
`
`A fee payment in the amount of $300 will be submitted with the form, representing payment for the allegation of use for 3 classes.
`
`A fee payment in the amount of $100 will be submitted with the form, representing payment for the request to divide fee.
`
`Declaration
`
`The attached signature image file:
`
`Original PDF file:
`hw_1744713130-120034707_._OCTAGON_GIRLS_SOU-Req_to_Div.pdf
`Converted PDF file(s) (1 page)
`Signature File1
`
`Signatory's Name: Timothy J. Bellamy
`Signatory's Position: Senior Vice President and Associate General Counsel
`
`Request to Divide Signature:
`
`Signature: /Jennifer Ko Craft/(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Date Signed: 06/24/2013
`Signatory's Name: Jennifer Ko Craft
`Signatory's Position: Attorney of Record, Nevada Bar Member
`
`The signatory has confirmed that he/she is an attorney who is a member in good standing of the bar of the highest court of a U.S. state, which
`includes the District of Columbia, Puerto Rico, and other federal territories and possessions; and he/she is currently the applicant's attorney or an
`associate thereof; and to the best of his/her knowledge, if prior to his/her appointment another U.S. attorney or a Canadian attorney/agent not
`currently associated with his/her company/firm previously represented the applicant in this matter: (1) the applicant has filed or is concurrently
`filing a signed revocation of or substitute power of attorney with the USPTO; (2) the USPTO has granted the request of the prior representative to
`withdraw; (3) the applicant has filed a power of attorney appointing him/her in this matter; or (4) the applicant's appointed U.S. attorney or
`Canadian attorney/agent has filed a power of attorney appointing him/her as an associate attorney in this matter.
`
`Serial Number: 77753015
`Internet Transmission Date: Tue Jun 25 12:04:40 EDT 2013
`TEAS Stamp: USPTO/SOU-XXX.XX.XX.XXX-2013062512044014
`7904-77753015-50081c681baa86e39b047ac66c
`1d8fd6d8670a2b8fce29432cd4eb07d507340d69
`
`

`

`2-CC-13014-2013062512003470705 8
`
`2-CC-13014-20130625120034707058
`
`

`

`Declaration
`
`Applicant requests registration of the above-identified trademark/service mark in the United States
`Patent and Trademark Office on the Principal Register established by the Act of July 5, 1946 (15 U.S.C.
`Section 1051 et seq., 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 goods/services identified above, as evidenced
`by the attached specimen(s) showing the mark as used in commerce.
`
`The undersigned, being hereby warned that willful false statements and the like so made are punishable
`by fine or imprisonment, or both, under 18 U.S.C. Section 1001, and that such willful false statements
`may jeopardize the validity of the form or any resulting registration, declares that he/she is properly
`authorized to execute this form on behalf of the applicant; he/she believes the applicant to be the owner
`of the trademark/service mark sought to be registered; and that all statements made of his/her own
`knowledge are true; and that all statements made on information and belief are believed to be true.
`
`Signature Section:
`
`Signature:
`Signatory's Name: Timothy J.’ Bellamy
`Signatory's Position: Senior Vice President and Associate General Counsel
`
`Date Signed: Q " Z ’;l*"2—4::| §
`
`NOTE TO APPLICANT: When filed as part of the 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 by itselfwill not 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 form to send to the signatory.
`
`

`

`FEE RECORD SHEET
`
`Serial Number:
`
`77753015
`
`RAM Sale Number: 77753015
`
`Total Fees:
`
`$400
`
`RAM Accounting Date: 20130625
`
`Transaction
`
`Transaction
`Date
`
`Fee per
`Class
`
`Number
`of Classes
`
`Statement of Use (SOU)
`Request to Divide (per new app.)
`
`20130625
`20130625
`
`$100
`
`Transaction Date:
`
`20130625
`
`