PTO/AIA/122 Change of Correspondence Address (Application)

Doc Code:

PTO/$,$/122 (-)
Approved for use through 11/30/201. OMB 0651-0035
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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CHANGE OF
CORRESPONDENCE ADDRESS
Application
Address to:
Commissioner for Patents
P.O. Box 1450
Alexandria, VA 22313-1450

Application Number
Filing Date
First Named Inventor
Art Unit
Examiner Name
Attorney Docket Number

Please change the Correspondence Address for the above-identified patent application to:
The address associated with
Customer Number:
OR
Firm or
Individual Name
Address

City

State

Zip

Country
Telephone

Email

This form cannot be used to change the data associated with a Customer Number. To change the
data associated with an existing Customer Number use “Request for Customer Number Data Change” (PTO/SB/124).
I am the:
Applicant
Attorney or agent of record. Registration Number _____________________.
Registered practitioner named in the application transmittal SDSHUVZKRDFWVLQDUHSUHVHQWDWLYHFDSDFLW\
XQGHU&)5. See 37 CFR 1.33(a)(1). Registration Number______________________.

Signature
Typed or Printed
Name
Telephone

Date

NOTE: 7KLVIRUPPXVWEHVLJQHGLQDFFRUGQDFHZLWK&)5. SHH&)5GIRUVLJQDWXUHUHTXLUHPHQWVDQGFHUWLILFDWLRQV
6ubmit multipleforms if more than one signature is required, see below*.
*Total of ____________forms are submitted.
This collection of information is required by 37 CFR 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
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