Fillable CHANGE OF Patent CORRESPONDENCE ADDRESS (USPTO)

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CHANGE OF Patent CORRESPONDENCE ADDRESS (USPTO)

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Doc Code:
PTO/AIA/123 (08-12)
Approved for use through 03/31/2021. 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.
CHANGE OF
CORRESPONDENCE ADDRESS
Patent
Address to:
Mail Stop Post Issue
Commissioner for Patents
P.O. Box 1450
Alexandria, VA 22313-1450
Patent Number
Issue Date
Application Number
Filing Date
First Named Inventor
Attorney Docket
Number
Please change the Correspondence Address for the above-identified patent 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).
This form will not affect any "fee address" provided for the above-identified patent. To change a "fee address" use the "Fee
Address Indication Form" (PTO/SB/47).
I am the:
Patentee.
If the Patentee was not the applicant for patent (37 CFR 1.42), then a Statement under 37 CFR 3.73(c)
(Form PTO/AIA/96 or equivalent) is enclosed or was filed on __________________. See 37 CFR 3.71.
Attorney or agent of record. Registration Number _____________________.
Patent practitioner acting in a representative capacity whose correspondence address is the correspondence
address of record. Notice has been given to the patentee or owner. Registration Number ____________________.
Signature
Typed or
Printed Name
Date Telephone
NOTE: This form must be signed in accordance with 37 CFR 1.33. See 37 CFR 1.4(d) for signature requirements and certifications.
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 1.33. 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: Mail Stop Post Issue, 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. 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
not furnish the requested information, the U.S. Patent and Trademark Office may not be able to
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. T
he information on this form will be treated confidentially to the extent allowed under
the
Freedo
m of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records fr
om
this
system of records may be disclosed to the Department of Justice to determine wh
ether
dis
closure of these records is required by the Freedom of Information Ac
t.
2.
A record from this system of records may be disclosed, as a routine use, in the course of
pres
enting evidence to a court, magistrate, or administrative tribunal, including disclosures
to
oppos
ing counsel in the course of settlement negotiations
.
3.
A rec
ord in this system of records may be disclosed, as a routine use, to a Mem
ber of
Congres
s submitting a request involving an individual, to whom the record pertains
, when the
indiv
idual has requested assistance from the Member with respect to the subject matter of
the
record.
4.
A rec
ord in this system of records may be disclosed, as a routine use, to a contractor of
the
Agenc
y having need for the information in order to perform a contract. Recipients o
f
inf
ormation shall be required to comply with the requirements of the Privacy Act of 197
4, as
am
ended, pursuant to 5 U.S.C. 552a(m)
.
5.
A record related to an International Application filed under the Patent Cooperation Treaty in
this
system of records may be disclosed, as a routine use, to the International Bureau of
the
W
orld Intellectual Property Organization, pursuant to the Patent Cooperation Treaty
.
6.
A rec
ord in this system of records may be disclosed, as a routine use, to another f
ederal
agenc
y for purposes of National Security review (35 U.S.C. 181) and for review pursu
ant to
the Atomic Energy Act (42 U.S.C. 218(c)).
7.
A rec
ord from this system of records may be disclosed, as a routine use, to the Adminis
trator,
G
eneral Services, or his/her designee, during an inspection of records conducted by G
SA as
part of
that agency’s responsibility to recommend improvements in records manageme
nt
prac
tices and programs, under authority of 44 U.S.C. 2904 and 2906. Such disclosure s
hall
be made in accordance with the GSA regulations governing inspection of records for this
purpos
e, and any other relevant (i.e., GSA or Commerce) directive. Such disclosure s
hall not
be us
ed to make determinations about individuals
.
8.
A rec
ord from this system of records may be disclosed, as a routine use, to the public af
ter
either public
ation of the application pursuant to 35 U.S.C. 122(b) or issuance of a pate
nt
pursuant to 35 U.S.C. 151. Further, a record may be disclosed, subject to the limitations of 37
CFR 1.14, as
a routine use, to the public if the record was filed in an application whic
h
bec
ame abandoned or in which the proceedings were terminated and which applicatio
n is
ref
erenced by either a published application, an application open to public inspecti
on or an
is
s
ued patent.
9. A rec
ord from this system of records may be disclosed, as a routine us
e, to a Federal, State,
or local law enforcement agency, if the USPTO becomes aware of a violation or potential
v
iolation of
law or regulation.
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Completed 17 July 2021

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