PTO/AIA/82A/B Transmittal for Power of Attorney to One or More Registe

PTO/AIA$ (07-12)
Approved for use through [[/[[/[[[[. OMB 0651-0035
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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TRANSMITTAL FOR POWER OF ATTORNEY TO ONE OR MORE
REGISTERED PRACTITIONERS
NOTE: This form is to be submitted with the Power of Attorney by ApplicantIRUP 372$,$%RUHTXLYDOHQWto identify the
application to which the Power of Attorney is directed, in accordance with 37 CFR 1.5. If the Power of Attorney by $SSOLFDQWIRUP
is not accompanied by this transmittal form or an equivalent, the Power of Attorney will not be recognized in the application.

Application Number
Filing Date
First Named Inventor
Title
Art Unit
Examiner Name
Attorney Docket Number
SIGNATURE of Applicant or Patent Practitioner

Signature

Date

Name

Telephone

5HJLVWUDWLRQ1XPEHU
NOTE: This form must be signed in accordance with 37 CFR 1.33.6HH&)5GIRUVLJQDWXUHUHTXLUHPHQWVDQGFHUWLILFDWLRQV

*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.

PTO/AIA/%(07-12)
Approved for use through 11/30/2014. 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 BY APPLICANT
I hereby revoke all previous powers of attorney given in the above-identified patent application.
I hereby appoint Practitioner(s) associated with the following Customer Number as my/our attorney(s) or agent(s), and to
transact all business inthe United States Patent and Trademark Office connected therewith forthe application UHIHUHQFHG
in the attached transmittal letterIRUP372$,$$RUHTXLYDOHQW:
OR
I hereby appoint Practitioner(s) named below as my/our attorney(s) or agent(s), and to transact all business in the
United States Patent and Trademark Office connected therewith for the application referenced in the attached
transmittal letterIRUP372$,$$RUHTXLYDOHQW:
Name Registration

Number

Number

Name Registration

Please recognize or change the correspondence address for the above-identified patent 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 Joint Inventor
Legal Representative of a Deceased or Legally Incapacitated Inventor

Assignee or Person to Whom the Inventor is Under an Obligation to Assign
Person Who Otherwise Shows Sufficient Proprietary Interest (e.g., a petition under 37 CFR 1.46(b)(2) was
granted in the application or is concurrently being filed with this document)
SIGNATURE of Applicant for Patent

Signature
Name

Date
Telephone

Title and Company
NOTE: Signature - This form must be signed by the applicant or applicant's representative in accordance with 37 CFR 1.33. See 37 CFR 1.4 for

signature requirements and certifications. Submit multiple forms for more than one signature, 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.

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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
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process and/or examine your submission, which may result in termination of proceedings or
abandonment of the application or expiration of the patent.
The information provided by you in this form will be subject to the following routine uses:
1.

2.

3.

4.

5.

6.

7.

8.

9.

The information on this form will be treated confidentially to the extent allowed under the
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