Any person who uses in this State a name, mark or device to indicate ownership of articles or supplies as defined in this Act may file in the office of the Secretary of State, on a form to be furnished or approved by him, a verified statement setting forth, but not limited to, the following information:

1. (a) The name and business address of the person filing the statement; and, if a corporation, the state of incorporation.
2. (b) The nature of the business of the applicant.

3. (c) The type of articles or supplies in connection with which the name, mark or device is used.

   The statement shall include or be accompanied by 3 copies, specimens, facsimiles or counterparts of such name, mark or device, and a filing fee of $10.

(from Ch. 140, par. 103)

(Source: Laws 1967, p. 1405.)