PTOL-85 Part B (Ha Fee(s) Transmittal

International Design Applications (Hague Agreement)

PTOL-85 Part B Fee(s) Transmittal

OMB: 0651-0075

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PART B – FEE(S) TRANSMITTAL
Complete and send this form, together with the applicable fee(s), by mail or fax, or via the USPTO patent electronic filing system.
By mail, send to:
Mail Stop ISSUE FEE
By fax, send to:
(571) 273-2885
Commissioner for Patents
P.O. Box 1450
Alexandria, VA 22313-1450
INSTRUCTIONS: This form should be used for transmitting the ISSUE FEE and PUBLICATION FEE (if required). Blocks 1 through 5 should be completed where appropriate.
All further correspondence will be mailed to the current correspondence address as indicated unless corrected below or directed otherwise in Block 1, by (a) specifying a new
correspondence address; and/or (b) indicating a separate “FEE ADDRESS” for maintenance fee notifications. Because electronic patent issuance may occur shortly after
issue fee payment, any desired continuing application should preferably be filed prior to payment of this issue fee in order not to jeopardize copendency.
CURRENT CORRESPONDENCE ADDRESS (Note: Use Block 1 for any change of address)
Note: A certificate of mailing can only be used for domestic mailings of the
Fee(s) Transmittal. This certificate cannot be used for any other accompanying
papers. Each additional paper, such as an assignment or formal drawing, must
have its own certificate of mailing or transmission.
Certificate of Mailing or Transmission
I hereby certify that this Fee(s) Transmittal is being deposited with the United
States Postal Service with sufficient postage for first class mail in an envelope
addressed to the Mail Stop ISSUE FEE address above, or being transmitted to the
USPTO via the USPTO patent electronic filing system or by facsimile to (571)
273-2885, on the date below.
(Typed or printed name)
(Signature)
(Date)
APPLICATION NO

FILING DATE

FIRST NAMED INVENTOR

ATTORNEY DOCKET NO

CONFIRMATION NO

TITLE OF INVENTION:
APPLN. TYPE

ENTITY STATUS

ISSUE FEE DUE

EXAMINER

PREV. PAID ISSUE FEE

ART UNIT

1. Change of correspondence address or indication of “Fee
Address” (37 CFR 1.363)
Change of correspondence address (or Change of
Correspondence Address form PTO/SB/122) attached.

3.

PUBLICATION FEE DUE

TOTAL FEE(S) DUE

DATE DUE

CLASS-SUBCLASS

2. For printing on the patent front page, list
(1) The names of up to 3 registered patent attorneys or
agents OR, alternatively,
(2) The name of a single firm (having as a member a
registered attorney or agent) and the names of up
to 2 registered patent attorneys or agents. If no
name is listed, no name will be printed.

“Fee Address” indication (or “Fee Address” Indication form
PTO/AIA/47 or PTO/SB/47; Rev 03-09 or more recent)
attached. Use of a Customer Number is required.
ASSIGNEE NAME AND RESIDENCE DATA TO BE PRINTED ON THE PATENT (print or type)

1.
2.
3.

PLEASE NOTE: Unless an assignee is identified below, no assignee data will appear on the patent. If an assignee is identified below, the document must have been
previously recorded, or filed for recordation, as set forth in 37 CFR 3.11 and 37 CFR 3.81(a). Completion of this form is NOT a substitute for filing an assignment.
(A) NAME OF ASSIGNEE
(B) RESIDENCE: (CITY and STATE or COUNTRY)

Please check the appropriate assignee category or categories (will not be printed on the patent):
4a. Fees Submitted:

Issue Fee

Individual

Corporation or other private group entity

Government

Publication Fee (if required)

4b. Method of Payment (Please first reapply any previously paid fee shown above):
Electronic Payment via the USPTO patent electronic filing system
Enclosed check
Non-electronic payment by credit card (Attach form PTO-2038)
The Director is hereby authorized to charge the required fee(s), any deficiency, or credit any overpayment to Deposit Account No. __________
5. Change of Entity Status (from status indicated above)
Applicant certifying micro entity status. See 37 CFR 1.29.

NOTE: Absent a valid Certification of Micro Entity Status (see forms PTO/SB/15A and 15B), issue fee
payment in the micro entity amount will not be accepted at the risk of application abandonment.

Applicant asserting small entity status. See 37 CFR 1.27.

NOTE: If the application was previously under micro entity status, checking this box will be taken as
a notification of loss of entitlement to micro entity status.

Applicant changing to regular undiscounted fee status.

NOTE: Checking this box will be taken as a notification of loss of entitlement to small or micro entity
status, as applicable.

NOTE: This form must be signed in accordance with 37 CFR 1.31 and 1.33. See 37 CFR 1.4 for signature requirements and certifications.
Authorized Signature

Date

Typed or printed name

Registration No.

PTOL-85 Part B (11-23) Approved for use through 03/31/2026

OMB 0651-0033

U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE

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