Form PTO/SB/81 Power of Attorney or Revocation of Power of Attorney wit

PTO/SB/81 (01-09)
Approved for use through 11/30/2011. OMB 0651-0035
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.

POWER OF ATTORNEY
OR
REVOCATION OF POWER OF ATTORNEY
WITH A NEW POWER OF ATTORNEY
AND
CHANGE OF CORRESPONDENCE ADDRESS

Application Number
Filing Date
First Named Inventor
Title
Art Unit

Examiner Name
Attorney Docket Number

I hereby revoke all previous powers of attorney given in the above-identified application.
A Power of Attorney is submitted herewith.
OR
I hereby appoint Practitioner(s) associated with the following Customer
Number as my/our attorney(s) or agent(s) to prosecute the application
identified above, and to transact all business in the United States Patent
and Trademark Office connected therewith:
OR
I hereby appoint Practitioner(s) named below as my/our attorney(s) or agent(s) to prosecute the application identified above, and
to transact all business in the United States Patent and Trademark Office connected therewith:
Practitioner(s) Name

Registration Number

Please recognize or change the correspondence address for the above-identified application to:
The address associated with the above-mentioned Customer Number.
OR
The address associated with Customer Number:
OR
Firm or
Individual Name
Address
City

State

Zip

Country
Telephone

Email

I am the:
Applicant/Inventor.
OR
Assignee of record of the entire interest. See 37 CFR 3.71.
Statement under 37 CFR 3.73(b) (Form PTO/SB/96) submitted herewith or filed on ______________________________.
SIGNATURE of Applicant or Assignee of Record
Signature

Date

Name

Telephone

Title and Company
NOTE: Signatures of all the inventors or assignees of record of the entire interest or their representative(s) are required. Submit multiple forms if more than one
signature is required, see below*.

*Total of ____________ forms are submitted.
This collection of information is required by 37 CFR 1.31, 1.32 and 1.33. The information is required to obtain or retain a benefit by the public which is to file (and by the
USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 3 minutes to complete,
including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any comments on
the amount of time you require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S. Patent and
Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS
ADDRESS. SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.

If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

Privacy Act Statement
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with
your submission of the attached form related to a patent application or patent. Accordingly, pursuant to
the requirements of the Act, please be advised that: (1) the general authority for the collection of this
information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary; and (3) the
principal purpose for which the information is used by the U.S. Patent and Trademark Office is to process
and/or examine your submission related to a patent application or patent. If you do not furnish the
requested information, the U.S. Patent and Trademark Office may not be able to process and/or examine
your submission, which may result in termination of proceedings or abandonment of the application or
expiration of the patent.
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Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records

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