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FEE ADDRESS INDICATION FORM (USPTO)

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Doc Code: MFEE.C.AD
Document Description: Maintenance Fee Address Change
PTO/AIA/47 (12-20)
Approved for use through 09/30/2021. OMB 0651-0016
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no person is required to respond to a collection of information unless it displays a valid OMB control number.
“FEE ADDRESS” INDICATION FORM
Address to:
Mail Stop Maintenance Fee
Director of the United States -OR-
Patent and Trademark Office
P.O. Box 1450
Alexandria, VA 22313-1450
Fax to:
571-273-6500
INSTRUCTIONS: The issue fee must have been paid for the application(s) listed on this form. In addition, only an address
represented by a Customer Number can be established as the fee address for maintenance fee purposes (hereafter, fee
address). A fee address should be established when correspondence related to maintenance fees should be mailed to a
different address than the correspondence address for the application.
When to check the first box below: If you have a Customer Number to represent the fee address.
When to check the second box below: If you have no Customer Number representing the desired fee address, in which case
a completed Request for Customer Number (PTO/SB/125) must be attached to this form. For more information on Customer
Numbers, see the Manual of Patent Examining Procedure (MPEP) § 403.
For the following listed application(s), please recognize as the “Fee Address” under the provisions of 37 CFR 1.363 the
address associated with:
Customer Number:
OR
The attached Request for Customer Number form (PTO/SB/125)
PATENT NUMBER
(if known)
APPLICATION NUMBER
Completed by (check one):
Applicant/Inventor
_________________________________________________
Signature
Attorney or Agent of record _______________
Reg. No.
_________________________________________________
Typed or printed name
Assignee of record of the entire interest. See
37 CFR 3.71. Statement under 37 CFR 3.73(c)
(Form PTO/AIA/96) is enclosed or was filed on
______________________________________
(Date)
_________________________________________________
Requester’s telephone number
_________________________________________________
Date
NOTE: Signatures of all the inventors or assignees of record of the entire interest or their representative(s) are required. If the assignee is a
juristic entity, this form must be signed by a patent practitioner (attorney or agent) of record. 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 1.363. The information is required to obtain or retain a benefit by the public, which is to indicate (and for the
USPTO to process) a fee address. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 5 minutes to complete,
including gathering, preparing, and submitting the completed 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 COMPLETED FORMS TO THE PREVIOUS ADDRESS. SEND COMPLETED
FORMS TO: Mail Stop Maintenance Fee, Director of the United States Patent and Trademark Office, 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. The information on this form will be treated confidentially to the extent allowed under the Freedom of
Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from this system of records
may be disclosed to the Department of Justice to determine whether disclosure of these records is
required by the Freedom of Information Act.
2. A record from this system of records may be disclosed, as a routine use, in the course of presenting
evidence to a court, magistrate, or administrative tribunal, including disclosures to opposing counsel in
the course of settlement negotiations.
3. A record in this system of records may be disclosed, as a routine use, to a Member of Congress
submitting a request involving an individual, to whom the record pertains, when the individual has
requested assistance from the Member with respect to the subject matter of the record.
4. A record in this system of records may be disclosed, as a routine use, to a contractor of the Agency
having need for the information in order to perform a contract. Recipients of information shall be required
to comply with the requirements of the Privacy Act of 1974, as amended, 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 World Intellectual
Property Organization, pursuant to the Patent Cooperation Treaty.
6. A record in this system of records may be disclosed, as a routine use, to another federal agency for
purposes of National Security review (35 U.S.C. 181) and for review pursuant to the Atomic Energy Act
(42 U.S.C. 218(c)).
7. A record from this system of records may be disclosed, as a routine use, to the Administrator, General
Services, or his/her designee, during an inspection of records conducted by GSA as part of that agency’s
responsibility to recommend improvements in records management practices and programs, under
authority of 44 U.S.C. 2904 and 2906. Such disclosure shall be made in accordance with the GSA
regulations governing inspection of records for this purpose, and any other relevant (i.e., GSA or
Commerce) directive. Such disclosure shall not be used to make determinations about individuals.
8. A record from this system of records may be disclosed, as a routine use, to the public after either
publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent 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 which became abandoned or in which the proceedings
were terminated and which application is referenced by either a published application, an application
open to public inspection or an issued patent.
9. A record from this system of records may be disclosed, as a routine use, to a Federal, State, or local law
enforcement agency, if the USPTO becomes aware of a violation or potential violation of law or
regulation.
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FEE ADDRESS INDICATION FORM (USPTO)

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Completed 17 July 2021

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