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Section 71 Declaration of Use Intake (Madrid Protocol)

Declaration of Continued Use/Excusable Nonuse in U.S. Commerce under 15 U.S.C. § 1141k.

Madrid Protocol Filing: Applies to U.S. extensions of protection under Section 66(a) / WIPO Madrid System[span_0](start_span)[span_0](end_span).

U.S. Registration Number *

WIPO International Reg. Number (IRN)

U.S. Registration Date *

Literal Mark Text *

Current Holder Name *

Check this box if current holder name differs from TSDR record (recorded assignment, merger, or legal name change).

Upload Chain-of-Title / Assignment Proof (PDF/JPG) *

Country of Domicile / Organization *

Holder / Representative Email *

Mailing Address *

City *

State / Postal Code *

Attorney Name

Law Firm Name

Bar Jurisdiction / State

Bar Membership Number

Attorney Email

Number of Classes Covered *

Signatory Relationship / Capacity *

Signatory Name *

Official Title *

Electronic Signature *