§ 40-1-103 — Application for registration; filing fee

(a) Subject to the limitations set forth in this act, any
person who uses a mark in this state may file in the office of
the secretary, in a manner complying with the requirements of
the secretary, an application for registration of that mark
setting forth, but not limited to, the following information:
(i) The name and business address of the person
applying for such registration; and, if a corporation, the state
of incorporation, or if a partnership, the state in which the
partnership is organized and the names of the general partners,
as specified by the secretary, or similar information for other
juristic persons, as specified by the secretary;
(ii) The goods or services on or in connection with
which the mark is used and the mode or manner in which the mark
is used on or in connection with such goods or services and the
class in which such goods or services fall;
(iii) The date when the mark was first used anywhere
and the date when it was first used in this state by the
applicant or a predecessor in interest;
(iv) A statement that the applicant is the owner of
the mark, that the mark is in use and that 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 thereof or in such
near resemblance as to be likely, when applied to the goods or
services of such other person, to cause confusion or to cause
mistake or to deceive; and
(v) If required by the secretary, a statement as to
whether an application to register the mark, or portions or a
composite, has been filed by the applicant or a predecessor in
interest in the United States patent and trademark office; and,
if so, the applicant shall provide full particulars including
the filing date and serial number of each application, the
status and, if any application was finally refused registration
or has otherwise not resulted in a registration, the reasons
therefor.
(b) The application shall be signed and verified by oath,
affirmation or declaration subject to perjury laws by the
applicant or by a member of the firm or an officer of the
corporation or association applying.
(c) The application shall be accompanied by a specimen or
facsimile of such mark in triplicate. The secretary may also
require that a drawing of the mark, complying with requirements
as the secretary may specify, accompany the application.
(d) The application for registration shall be accompanied
by a filing fee, set in accordance with W.S. 40-1-116, but not
to exceed three hundred dollars ($300.00) and payable to the
secretary.