Form PTO 1595 PTO 1595 Recordation Form Cover Sheet

Form PTO-1595

U.S. DEPARTMENT OF COMMERCE
United States Patent and Trademark Office

OMB No. 0651-0027 (non-Hague exp. 04/30/2015)
OMB No. 0651-0075 (Hague exp. 07/XX/2017)

RECORDATION FORM COVER SHEET

PATENTS ONLY
To the Director of the U.S. Patent and Trademark Office: Please record the attached documents or the new address(es) below.

2. Name and address of receiving party(ies)
Name: ____________________________________
Internal Address: ____________________________
Additional name(s) of conveying party(ies) attached?

Yes

No

___________________________________________________

Street Address: _____ ________________________
3. Nature of conveyance/Execution Date(s):
Execution Date(s) ______________ _______________
___________________________________________________

Assignment

Merger

Security Agreement

Change of Name

Joint Research Agreement

City:______________________________________
State: _____________________________________

Government Interest Assignment

Country:___________________Zip:______________

Executive Order 9424, Confirmatory License

Other__________________________________
4. Application or patent number(s):
A. Patent Application No.(s)

Additional name(s) & address(es) attached?

Yes

N

This document serves as an Oath/Declaration (37 CFR 1.63).
B. Patent No.(s)

Additional numbers attached?

5. Name and address to whom correspondence
concerning document should be mailed:
Name:_____________________________________

Yes

No

6. Total number of applications and patents
involved:

7. Total fee (37 CFR 1.21(h) & 3.41) $____________

_
______________________
Internal Address _______

___________________________________________

Authorized to be charged to deposit account

Street Address:

Enclosed

___________________________________________

None required (government interest not affecting title)
8. Payment Information

City:
State:_____________________Zip:_______________
Phone Number:_______________________________
Docket Number:_______________________________
Email Address: _______________________________

Deposit Account Number __________________
Authorized User Name_____________________

9. Signature
Signature
Name of Person Signing

Date
Total number of pages including cover
sheet, attachments, and documents:

Documents to be recorded (including cover sheet) should be faxed to (571) 273-0140, or mailed to:
Mail Stop Assignment Recordation Services, Director of the USPTO, P.O.Box 1450, Alexandria, V.A. 22313-14

Guidelines for Completing Patents Cover Sheets
(PTO-1595)
Cover sheet information must be submitted with each document to be recorded. If the document to be
recorded concerns both patents and trademarks separate patent and trademark cover sheets, including any
attached pages for continuing information, must accompany the document. All pages of the cover sheet should
be numbered consecutively, for example, if both a patent and trademark cover sheet is used, and information is
continued on one additional page for both patents and trademarks, the pages of the cover sheet would be
numbered from 1 to 4.
Item 1. Name of Conveying Party(ies).
Enter the full name of the party(ies) conveying the interest. If there is insufficient space, enter a check
mark in the "Yes" box to indicate that additional information is attached. The name of the additional conveying
party(ies) should be placed on an attached page clearly identified as a continuation of the information Item 1.
Enter a check mark in the "No" box, if no information is contained on an attached page. If the document to be
recorded is a joint research agreement, enter the name(s) of the party(ies) other than the owner of the patent or
patent application as the conveying party(ies).
Item 2. Name and Address of Receiving Party(ies).
Enter the name and full address of the first party receiving the interest. If there is more than one party
receiving the interest, enter a check mark in the "Yes" box to indicate that additional information is attached.
Enter a check mark in the "No" box, if no information is contained on an attached page. If the document to be
recorded is a joint research agreement, enter the name(s) of the patent or patent application owner(s) as the
receiving party.
Item 3. Nature of Conveyance/Execution Date(s).
Enter the execution date(s) of the document. It is preferable to use the name of the month, or an
abbreviation of that name, in order that confusion over dates is minimized. Place a check mark in the
appropriate box describing the nature of the conveying document. If the "Other" box is checked, specify the
nature of the conveyance.
Item 4. Application Number(s) or Patent Number(s).
Indicate the application number(s), and/or patent number(s) against which the document is to be
recorded. National application numbers must include both the series code and a six-digit number (e.g.,
07/123,456), and international application numbers must be complete (e.g., PCT/US91/12345). An international
design application for which a national application number has not been assigned may be indicated by the
international registration number (e.g., DM/123456).
Enter a check mark in the appropriate box: "Yes" or "No " if additional numbers appear on attached
pages. Be sure to identify numbers included on attached pages as the continuation of Item 4. Also enter a
check mark if this Assignment is being filed as an Oath/Declaration (37 CFR 1.63).
Item 5. Name and Address of Party to whom correspondence concerning the document should be
mailed. Enter the name and full address of the party to whom correspondence is to be mailed.
Item 6. Total Applications and Patents involved.
Enter the total number of applications and patents identified for recordation. Be sure to include all
applications and patents identified on the cover sheet and on additional pages.
Block 7. Total Fee Enclosed.
Enter the total fee enclosed or authorized to be charged. A fee is required for each application and
patent against which the document is recorded.
Item 8. Payment Information.
Enter the deposit account number and authorized user name to authorize charges.
Item 9. Signature.
Enter the name of the person submitting the document. The submitter must sign and date the cover
sheet. Enter the total number of pages including the cover sheet, attachments, and document.
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.
This collection of information is required by 35 USC 261 and 262 and 15 USC 1057 and 1060. The information is used by the public to submit (and by the USPTO to
process) patent and trademark assignment requests. After the USPTO records the information, the records for patent and trademarks, assignments, and other associated
documents can be inspected by the public. To view documents recorded under secrecy orders or documents recorded due to the interest of the federal government, a
written authorization must be submitted. This collection is estimated to take 30 minutes to complete, including gathering, preparing, and submitting the form to the
USPTO. 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 Manager of the
Assignment Division, USPTO, P.O. Box 1450, Alexandria, VA 22313-1450.
DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Mail Stop Assignment Recordation Services, Director of the USPTO, P.O. Box 1450,
Alexandria, VA 22313-1450.

Privacy Act Statement for Patent Assignment Recordation Form Cover Sheet
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection
with the above request for information. This collection of information is authorized by 35 U.S.C. 1, 2,
261 and E.O. 9424. This information will primarily be used by the USPTO for the recordation of
assignments related to patents and patent applications. Submission of this information is voluntary
but is required in order for the USPTO to record the requested assignment. If you do not provide the
information required on the cover sheet, the assignment will not be recorded, and all documents will
be returned to you.
After the information is recorded, the records and associated documents can be inspected by the
public and are not confidential, except for documents that are sealed under secrecy orders or
related to unpublished patent applications. Assignment records relating to unpublished patent
applications are maintained in confidence in accordance with 35 U.S.C. 122. Records open to the
public are searched by users for the purpose of determining ownership for other property rights with
respect to patents and trademarks.

Routine uses of the information you provide may also include disclosure to appropriate Federal,
state, local, or foreign agencies in support of their enforcement duties and statutory or regulatory
missions, including investigating potential violations of law or contract and awarding contracts or
other benefits; to a court, magistrate, or administrative tribunal in the course of presenting evidence;
to members of Congress responding to requests for assistance from their constituents; to the Office
of Management and Budget in connection with the review of private relief legislation; to the
Department of Justice in connection with a Freedom of Information Act request; to a contractor in
the performance of their duties; to the Office of Personnel Management for personnel studies; and to
the General Services Administration (GSA) as part of their records management responsibilities
under the authority of 44 U.S.C. 2904 and 2906. Such disclosure to GSA shall not be used to make
determinations about individuals.