Form Dos 246 PDF Details

Form Dos 246 is a form used for the preliminary notification of an incident to the Health and Safety Executive (HSE). The purpose of this form is to provide information about the incident, including what happened, where it happened, and how many people were injured. This form should be completed as soon as possible after the incident occurs. Completing this form can help ensure that the HSE can investigate the incident and take appropriate action.

QuestionAnswer
Form NameForm Dos 246
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesservicemarks, federally, Servicemark, Unit1

Form Preview Example

NYS DEPARTMENT OF STATE

MISCELLANEOUS RECORDS

One Commerce Plaza, 99 Washington Avenue

Albany, NY 12231-0001

http://www.dos.state.ny.us

Original Application to Register a Servicemark

REG NO

Please read the instructions prior to completing this form; attach additional sheets as needed.

1. APPLICANT NAME

2. ADDRESS NUMBER AND STREET

CITY

STATE

ZIP

3.IF A CORPORATION, ENTER STATE IN WHICH INCORPORATED AND IF A PARTNERSHIP, ENTER STATE IN WHICH ORGANIZED

4.IF A PARTNERSHIP, LIST THE NAMES OF ALL GENERAL PARTNERS

5. DESCRIBE THE SERVICEMARK, INCLUDING A WRITTEN DESCRIPTION OF DESIGN FEATURES, IF ANY (DO NOT GLUE A FACSIMILE TO THIS FORM)

6.STATE THE SPECIFIC SERVICES FOR WHICH THE MARK IS USED

7.DESCRIBE THE MODE OR MANNER IN WHICH THE MARK IS USED

8. CLASS NUMBER(S)

9. DATE OF

(A) IN NEW YORK STATE

(B) ANYWHERE

FIRST USE

 

 

FOR OFFICE USE ONLY

The applicant is the owner of the mark, the mark is in use, and, to the knowledge of the person verifying the application, no other person has registered, either federally or in this state, or has the right to use such mark either in the identical form or in such near resemblance as to be likely, when applied to the services of such other person, to cause confusion, or to cause mistake, or to deceive.

The undersigned applies to register the aforesaid mark pursuant to Article 24 of the General Business Law and affirms under the penalties of perjury that the statements herein made, including any attached papers, are true.

(Corporation, Association, Firm, etc.)

By:

(Signature and Title of Officer)

 

(Date)

DOS-246 (Rev. 5/08)

Instructions: Please refer to the instruction sheet for completion of items 1 through 9 of the registration form.

Definition: The term “servicemark” means any word, name, symbol or device or any combination thereof used by a person to identify and distinguish the services of one person, including a unique service, from the services of others, and to indicate the source of the services, even if the source is unknown. Titles, character names used by a person, and other distinctive features of radio or television programs may be registered as servicemarks not withstanding that they, or the programs, may advertise the goods of the sponsor.

General Classes of Services:

Class

Title

Class

Title

35

Advertising and Business

39

Transportation and Storage

36

Insurance and Financial

40

Material treatment

37

Construction and Repair

41

Education and Entertainment

38

Communication

42

Miscellaneous

Please note there is a $50 filing fee for EACH CLASSIFICATION claimed for registration.

Application Form: The application must be on a current form supplied by the Department of State and be completed in the English language and plainly written or typed. If the mark or any part thereof is not in the English language, it must be accompanied by a sworn, notarized, translation.

Specimens of the Mark: The application must be accompanied by three specimens (examples) showing the mark as actually used. Specimens are not to be stapled or glued to the form.

Mail to: Please mail the completed application form together with the filing fee and three specimens of the mark

to: New York State Department of State, Miscellaneous Records Unit,1 Commerce Plaza, 99 Washington Avenue Albany, NY 12231-0001.

Questions: If you have any questions or require assistance completing this form, please write to the Department of State, Miscellaneous Records Unit at the above address or call (518) 474-4770.

Payment: Checks or money orders should be made payable to the “Department of State.” Please do not send cash through the mail.

How to Edit Form Dos 246 Online for Free

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Step 1: Click on the orange "Get Form" button above. It's going to open up our pdf tool so you can start filling out your form.

Step 2: As soon as you access the editor, you will get the form ready to be completed. Apart from filling out various blanks, you might also do several other things with the form, that is adding any words, editing the initial text, adding graphics, putting your signature on the form, and a lot more.

For you to finalize this PDF form, make sure you enter the right details in each and every blank:

1. The Servicemark usually requires certain details to be inserted. Be sure the subsequent blanks are complete:

Simple tips to prepare Washington step 1

2. The next part is to fill in the following blanks: STATE THE SPECIFIC SERVICES FOR, DESCRIBE THE MODE OR MANNER IN, CLASS NUMBERS, DATE OF FIRST USE, A IN NEW YORK STATE, B ANYWHERE, FOR OFFICE USE ONLY, The applicant is the owner of the, The undersigned applies to, and Corporation Association Firm etc.

Step # 2 of submitting Washington

3. Within this part, check out Signature and Title of Officer, Date, and DOS Rev. Each one of these will have to be filled out with highest precision.

Signature and Title of Officer, DOS Rev, and Date inside Washington

People frequently make some errors when filling in Signature and Title of Officer in this part. Be sure you read twice everything you enter right here.

Step 3: Once you have glanced through the information in the blanks, simply click "Done" to finalize your document creation. Make a 7-day free trial subscription with us and get immediate access to Servicemark - readily available from your FormsPal cabinet. Here at FormsPal, we do our utmost to make sure all your information is kept secure.

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