`PTO Form 1963 (Rev 05/2006)
`
`OMB No. 0651-0055 (Exp 07/31/2018)
`
`Combined Declaration of Use and/or Excusable Nonuse/Application for Renewal of
`Registration of a Mark under Sections 8 & 9
`
`The table below presents the data as entered.
`
`Input Field
`
`REGISTRATION NUMBER
`
`REGISTRATION DATE
`
`SERIAL NUMBER
`
`MARK SECTION
`
`MARK
`
`ATTORNEY SECTION (current)
`
`NAME
`
`FIRM NAME
`
`INTERNAL ADDRESS
`
`STREET
`
`CITY
`
`STATE
`
`POSTAL CODE
`
`COUNTRY
`
`PHONE
`
`FAX
`
`
`Entered
`
`3208556
`
`02/13/2007
`
`78858783
`
`GHOST
`
`Bruce J. Bowman
`
`BOWMAN & ASSOCIATES
`
`Suite 106
`
`1016 3RD AVE SW
`
`CARMEL
`
`Indiana
`
`46032-7607
`
`United States
`
`317 571-9301
`
`317 571-9302
`
`bowmanassociates@sbcglobal.net
`
`AUTHORIZED TO COMMUNICATE VIA E-MAIL
`
`DOCKET/REFERENCE NUMBER
`
`ATTORNEY SECTION (proposed)
`
`Yes
`
`LSP019
`
`NAME
`
`FIRM NAME
`
`INTERNAL ADDRESS
`
`STREET
`
`CITY
`
`STATE
`
`POSTAL CODE
`
`COUNTRY
`
`PHONE
`
`
`Bruce J. Bowman
`
`Indiano & McConnell LLP
`
`Suite 185
`
`9795 Crosspoint Blvd.
`
`Indianapolis
`
`Indiana
`
`46256
`
`United States
`
`317 912-1331
`
`bruce@im-iplaw.com
`
`
`
`AUTHORIZED TO COMMUNICATE VIA E-MAIL
`
`DOCKET/REFERENCE NUMBER
`
`CORRESPONDENCE SECTION (current)
`
`Yes
`
`LSP019
`
`NAME
`
`FIRM NAME
`
`INTERNAL ADDRESS
`
`STREET
`
`CITY
`
`STATE
`
`POSTAL CODE
`
`COUNTRY
`
`PHONE
`
`FAX
`
`
`Bruce J. Bowman
`
`BOWMAN & ASSOCIATES
`
`Suite 106
`
`1016 3RD AVE SW
`
`CARMEL
`
`Indiana
`
`46032-7607
`
`United States
`
`317 571-9301
`
`317 571-9302
`
`bowmanassociates@sbcglobal.net
`
`AUTHORIZED TO COMMUNICATE VIA E-MAIL
`
`DOCKET/REFERENCE NUMBER
`
`CORRESPONDENCE SECTION (proposed)
`
`Yes
`
`LSP019
`
`NAME
`
`FIRM NAME
`
`INTERNAL ADDRESS
`
`STREET
`
`CITY
`
`STATE
`
`POSTAL CODE
`
`COUNTRY
`
`PHONE
`
`
`AUTHORIZED TO COMMUNICATE VIA E-MAIL
`
`DOCKET/REFERENCE NUMBER
`
`GOODS AND/OR SERVICES SECTION
`
`INTERNATIONAL CLASS
`
`GOODS OR SERVICES
`
`SPECIMEN FILE NAME(S)
`
`SPECIMEN DESCRIPTION
`
`OWNER SECTION (current)
`
`Bruce J. Bowman
`
`Indiano & McConnell LLP
`
`Suite 185
`
`9795 Crosspoint Blvd.
`
`Indianapolis
`
`Indiana
`
`46256
`
`United States
`
`317 912-1331
`
`bruce@im-iplaw.com
`
`Yes
`
`LSP019
`
`010
`
`Implants consisting of artificial materials, namely, orthopedic devices for
`the spine, spinal body replacement devices, intravertebral body replacement
`devices, spinal interbody devices
`
`\\TICRS\EXPORT16\IMAGEOUT 16\788\587\78858783\xml3\
`S890002.JPG
`
`a digital photograph of packaged goods
`
`NAME
`
`Life Spine, Inc.
`
`
`
`STREET
`
`CITY
`
`STATE
`
`ZIP/POSTAL CODE
`
`COUNTRY
`
`PHONE
`
`FAX
`
`LEGAL ENTITY SECTION (current)
`
`TYPE
`
`STATE/COUNTRY OF INCORPORATION
`
`PAYMENT SECTION
`
`NUMBER OF CLASSES
`
`NUMBER OF CLASSES PAID
`
`SUBTOTAL AMOUNT
`
`TOTAL FEE PAID
`
`SIGNATURE SECTION
`
`SIGNATURE
`
`SIGNATORY'S NAME
`
`SIGNATORY'S POSITION
`
`DATE SIGNED
`
`SIGNATORY'S PHONE NUMBER
`
`PAYMENT METHOD
`
`SUBMIT DATE
`
`TEAS STAMP
`
`13951 S. Quality Dr.
`
`Huntley
`
`Illinois
`
`60142
`
`United States
`
`847.884.6117
`
`847.884.6118
`
`corporation
`
`Delaware
`
`1
`
`1
`
`400
`
`400
`
`/Bruce J. Bowman/
`
`Bruce J. Bowman
`
`Attorney of record, Indiana bar member
`
`04/12/2016
`
`317 912-1331
`
`CC
`
`FILING INFORMATION
`
`Tue Apr 12 11:36:58 EDT 2016
`
`USPTO/S08N09-XXX.XXX.XX.X
`XX-20160412113658149903-3
`208556-550a5b44738307467f
`3464b91b3167182b9dc092dc6
`370fe524e6b4467b6f194-CC-
`9258-20160412113037344197
`
`
`
`Under the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number.
`PTO Form 1963 (Rev 05/2006)
`
`OMB No. 0651-0055 (Exp 07/31/2018)
`
`Combined Declaration of Use and/or Excusable Nonuse/Application for Renewal of Registration of a Mark under
`Sections 8 & 9
`
`To the Commissioner for Trademarks:
`
`REGISTRATION NUMBER:(cid:160)3208556
`REGISTRATION DATE:(cid:160)02/13/2007
`
`MARK: GHOST
`
`The owner, Life Spine, Inc., a corporation of Delaware, having an address of
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)13951 S. Quality Dr.
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Huntley, Illinois 60142
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)United States
`is filing a Combined Declaration of Use and/or Excusable Nonuse/Application for Renewal of Registration of a Mark under Sections 8 & 9.
`
`For International Class 010, the mark is in use in commerce on or in connection with all goods/services, or to indicate membership in the
`collective membership organization, listed in the existing registration for this specific class: Implants consisting of artificial materials, namely,
`orthopedic devices for the spine, spinal body replacement devices, intravertebral body replacement devices, spinal interbody devices ; or, the
`owner is making the listed excusable nonuse claim.
`
`The owner is submitting one(or more) specimen(s) showing the mark as used in commerce on or in connection with any item in this class,
`consisting of a(n) a digital photograph of packaged goods.
`Specimen File1
`The registrant's current Attorney Information: Bruce J. Bowman of (cid:160)BOWMAN & ASSOCIATES
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Suite 106
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)1016 3RD AVE SW
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)CARMEL, Indiana 46032-7607
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)United States
`The docket/reference number is LSP019.
`
`The registrant's proposed Attorney Information: Bruce J. Bowman of (cid:160)Indiano & McConnell LLP
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Suite 185
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)9795 Crosspoint Blvd.
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Indianapolis, Indiana 46256
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)United States
`The docket/reference number is LSP019.
`
`The phone number is 317 912-1331.
`
`The email address is bruce@im-iplaw.com.
`The registrant's current Correspondence Information: Bruce J. Bowman of (cid:160)BOWMAN & ASSOCIATES
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Suite 106
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)1016 3RD AVE SW
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)CARMEL, Indiana 46032-7607
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)United States
`The docket/reference number is LSP019.
`
`The registrant's proposed Correspondence Information: Bruce J. Bowman of (cid:160)Indiano & McConnell LLP
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Suite 185
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)9795 Crosspoint Blvd.
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Indianapolis, Indiana 46256
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)United States
`The docket/reference number is LSP019.
`
`
`
`The phone number is 317 912-1331.
`
`The email address is bruce@im-iplaw.com.
`
`A fee payment in the amount of $400 will be submitted with the form, representing payment for 1 class(es), plus any additional grace period fee,
`if necessary.
`
`Declaration
`
`Section 8: Declaration of Use and/or Excusable Nonuse in Commerce
`Unless the owner has specifically claimed excusable nonuse, the mark is in use in commerce on or in connection with the goods/services, or to
`indicate membership in the collective membership organization identified above, as evidenced by the attached specimen(s) showing the mark as
`used in commerce.
`
`The signatory being warned that willful false statements and the like are punishable by fine or imprisonment, or both, under 18 U.S.C. § 1001,
`and that such willful false statements and the like may jeopardize the validity of this submission, declares that all statements made of his/her own
`knowledge are true and all statements made on information and belief are believed to be true.
`
`Section 9: Application for Renewal
`The registrant requests that the registration be renewed for the goods/services/collective organization identified above.
`
`Signature: /Bruce J. Bowman/(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Date: 04/12/2016
`Signatory's Name: Bruce J. Bowman
`Signatory's Position: Attorney of record, Indiana bar member
`Signatory's Phone Number: 317 912-1331
`
`Mailing Address (current):
`(cid:160)(cid:160)(cid:160)BOWMAN & ASSOCIATES
`(cid:160)(cid:160)(cid:160)1016 3RD AVE SW
`(cid:160)(cid:160)(cid:160)CARMEL, Indiana 46032-7607
`
`Mailing Address (proposed):
`(cid:160)(cid:160)(cid:160)Indiano & McConnell LLP
`(cid:160)(cid:160)(cid:160)9795 Crosspoint Blvd.
`(cid:160)(cid:160)(cid:160)Indianapolis, Indiana 46256
`
`Serial Number: 78858783
`Internet Transmission Date: Tue Apr 12 11:36:58 EDT 2016
`TEAS Stamp: USPTO/S08N09-XXX.XXX.XX.XXX-201604121136
`58149903-3208556-550a5b44738307467f3464b
`91b3167182b9dc092dc6370fe524e6b4467b6f19
`4-CC-9258-20160412113037344197
`
`
`
`
`
`ROUTING SHEET TO POST REGISTRATION (PRU)
`
`Registration Number?
`
`3203556
`
`Serial Number:
`
`78858783
`
`RAM Sale Number: 3208556
`
`RAM Accounting Date: 20160412
`
`Total Fees:
`
`$400
`
`Note: Process in accordance with Post Registration Standard Operating Procedure (SOP)
`
`Transaction
`
`Transaction
`Date
`
`Fee per
`Class
`
`Number
`of Classes
`
`Number of
`Classes Paid
`
`§8 affidavit
`Application for Renewal (§9)
`
`20160412
`20160412
`
`$100
`$3 00
`
`Physical Location: 900 - FILE REPOSITORY (FRANCONIA)
`
`Lost Case Flag: False
`
`In TICRS (AM—FLG—IN—TICRS): True
`
`Transaction Date:
`
`20160412

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