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

PTO/SB/81 (01-09)

Approved for use through XX/XX/XXXX. 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
C HANGE OF CORRESPONDENCE ADDRESS

Application Number
Filing Date
First Named Inventor

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 and 1.32. 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 Administration 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. The United States Patent and Trademark
Office (USPTO) collects this information under authority of 37 CFR 1.31 and 1.32. This information is covered by a
System of Records Notice (SORN) which identifies the categories of individuals covered by the system including
inventors, legal representatives for inventors, and other persons authorized by law to make applications for patent. The
information in this system of records is used to manage all records of applicants and legal representatives including
name, citizenship, residence, post office address and other information pertaining to activities in connection with the
invention for which a patent is sought.
The information obtain is protected from disclosure to third parties in accordance with the Privacy Act. However, routine
uses of this information may include disclosure to the following: to law enforcement and investigation in the event that
the system of records indicates a violation or potential violation of law; to a Federal, state, local, or international
agency, in response to its request; to an agency, organization, or individual for the purpose of performing audit or
oversight operations as authorized by law; to non-federal personnel under contract to the agency; to a court for
adjudication and litigation; to the Department of Justice for Freedom of Information Act (FOIA) assistance; to members
of congress working on behalf of an individual; to the Office of Personnel Management (OPM) for personnel research
purposes; to National Archives and Records Administration for inspection of records; and to the Office of Management
and Budget (OMB)for legislative coordination and clearance. Failure to provide any part of the requested information
may result in an inability to process requests for access and information. The applicable Privacy Act System of Records
Notice for this information is COMMERCE/PAT-TM-7 Patent Application Files, available at Federal Register /Vol. 78,
No. 61 / Friday, March 29, 2013 /Notices 19243. https://www.govinfo.gov/content/pkg/FR-2013-03-29/
pdf/2013-07341.pdf