Trademark/Service Mark Application, Principal Register
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1 PTO Form 1478 (Rev 9/2006) OMB No (Exp 12/31/2011) Trademark/Service Mark Application, Principal Register Serial Number: Filing Date: 01/11/2012 The table below presents the data as entered. Input Field Entered SERIAL NUMBER MARK INFORMATION *MARK STANDARD CHARACTERS USPTO-GENERATED IMAGE LITERAL ELEMENT MARK STATEMENT REGISTER SiLoc YES YES SiLoc The mark consists of standard characters, without claim to any particular font, style, size, or color. Principal APPLICANT INFORMATION *OWNER OF MARK INTERNAL ADDRESS Suite 201 *STREET *CITY *STATE (Required for U.S. applicants) *COUNTRY *ZIP/POSTAL CODE (Required for U.S. applicants only) St. Petersburg Florida United States PHONE FAX ADDRESS AUTHORIZED TO COMMUNICATE VIA Yes LEGAL ENTITY INFORMATION
2 TYPE STATE/COUNTRY WHERE LEGALLY ORGANIZED limited liability company Delaware GOODS AND/OR SERVICES AND BASIS INFORMATION INTERNATIONAL CLASS 005 *IDENTIFICATION FILING BASIS Biological bone tissue intended for subsequent implantation; surgical implants comprising biological bone tissue; implants for use in the sacroiliac joint composed of living autograft, allograft, biological or other living biocompatible materials SECTION 1(b) INTERNATIONAL CLASS 010 *IDENTIFICATION FILING BASIS Implants for use in the sacroiliac joint composed primarily of artificial materials and also incorporating allograft, biological or other biocompatible materials SECTION 1(b) CORRESPONDENCE INFORMATION NAME FIRM NAME INTERNAL ADDRESS Suite 201 STREET CITY STATE COUNTRY St. Petersburg Florida United States ZIP/POSTAL CODE PHONE FAX ADDRESS AUTHORIZED TO COMMUNICATE VIA Yes FEE INFORMATION NUMBER OF CLASSES 2 FEE PER CLASS 325
3 *TOTAL FEE DUE 650 *TOTAL FEE PAID 650 SIGNATURE INFORMATION SIGNATURE SIGNATORY'S NAME SIGNATORY'S POSITION /Tov Vestgaarden/ Tov Vestgaarden President and Chief Technical Officer DATE SIGNED 01/11/2012
4 PTO Form 1478 (Rev 9/2006) OMB No (Exp 12/31/2011) Trademark/Service Mark Application, Principal Register Serial Number: Filing Date: 01/11/2012 To the Commissioner for Trademarks: MARK: SiLoc (Standard Characters, see mark) The literal element of the mark consists of SiLoc. The mark consists of standard characters, without claim to any particular font, style, size, or color. The applicant,, a limited liability company legally organized under the laws of Delaware, having an address of Suite 201, St. Petersburg, Florida United States requests registration of the trademark/service mark identified above 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, for the following: International Class 005: Biological bone tissue intended for subsequent implantation; surgical implants comprising biological bone tissue; implants for use in the sacroiliac joint composed of living autograft, allograft, biological or other living biocompatible materials Intent to Use: The applicant has a bona fide intention to use or use through the applicant's related company or licensee the mark in commerce on or in connection with the identified goods and/or services. (15 U.S.C. Section 1051(b)). International Class 010: Implants for use in the sacroiliac joint composed primarily of artificial materials and also incorporating allograft, biological or other biocompatible materials Intent to Use: The applicant has a bona fide intention to use or use through the applicant's related company or licensee the mark in commerce on or in connection with the identified goods and/or services. (15 U.S.C. Section 1051(b)). The applicant's current Correspondence Information: Suite 201 St. Petersburg, Florida (phone) (fax)
5 (authorized) A fee payment in the amount of $650 has been submitted with the application, representing payment for 2 class(es). Declaration 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, and the like, may jeopardize the validity of the application or any resulting registration, declares that he/she is properly authorized to execute this application on behalf of the applicant; he/she believes the applicant to be the owner of the trademark/service mark sought to be registered, or, if the application is being filed under 15 U.S.C. Section 1051(b), he/she believes applicant to be entitled to use such mark in commerce; to the best of his/her knowledge and belief no other person, firm, corporation, or association has the right to use the mark in commerce, either in the identical form thereof or in such near resemblance thereto as to be likely, when used on or in connection with the goods/services of such other person, to cause confusion, or to cause mistake, or to deceive; 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: /Tov Vestgaarden/ Date Signed: 01/11/2012 Signatory's Name: Tov Vestgaarden Signatory's Position: President and Chief Technical Officer RAM Sale Number: 7995 RAM Accounting Date: 01/11/2012 Serial Number: Internet Transmission Date: Wed Jan 11 10:00:48 EST 2012 TEAS Stamp: USPTO/BAS b1d0ae9ee f4d d63ae5-CC
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Trademark/Service Mark Application, Principal Register
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