Form PTO-1594 (Rev. 6-12)
MB Collection 0651-0027 (exp. 04/30/2018)
United States Patent and Trademark Office
To the Director of the U. S. Patent and Trademark Office: Please record the attached documents or the new address(es) below.
1. Name of conveying party(ies): 2. Name and address of receiving party(ies)
3. Nature of conveyance/Execution Date(s) :
Security Agreement
Change of Name
If assignee is not domiciled in the United States, a domestic
representative designation is attached:
Additional names, addresses, or citizenship attached?
Limited Partnership
Corporation Citizenship____________________________
Yes No
4. Application number(s) or registration number(s) and identification or description of the Trademark.
A. Trademark Application No.(s)
B. Trademark Registration No.(s)
Additional sheet(s) attached?
Yes No
5. Name & address of party to whom correspondence
concerning document should be mailed:
6. Total number of applications and
registrations involved:
7. Total fee (37 CFR 2.6(b)(6) & 3.41)
Internal Address: ________________________________
9. Signature:
Total number of pages including cover
sheet, attachments, and document:
Name of Person Signing
Documents to be recorded (including cover sheet) should be faxed to (571) 273-0140, or mailed to:
ail Stop Assignment Recordation Branch, Director of the USPTO, P.O. Box 1450, Alexandria, VA 22313-1450
State: ____________________
Corporation- State:
Limited Partnership
Additional names of conveying parties attached?
Yes No
Citizenship (see guidelines)
Phone Number: _________________________________
il Address: _________________________________
rized to be charged to deposit account
8. Payment Information:
Deposit Account Number _____________________
Citizenship ___________________
C. Identification or Description of Trademark(s) (and Filing Date if Application or Registration Number is unknown):
Authorized User Name
State: ________________________________________
(Designations must be a separate document from assignment)
Docket Number:
Execution Date(s) _______________________________
Guidelines for Completing Trademarks Cover Sheets (PTO-1594)
Cover Sheet information must be submitted with each document to be recorded. If the document to be recorded
concerns both patents and trad
emarks, separate patent and trademark cover sheets, including any attached pages for
continuing info
rmation, must accompany the document. All pages of the cover sheet should be numbered consecutively for
xample, 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.
1. Name of Conveying Party(ies).
Enter the fu
ll name of the party(ies) conveying the interest. If there is more than one conveying party, enter a check
rk in the "Yes" box to indicate that additional information is attached. The name of the second and any subsequent
conveying party(ies) should be pl
aced on an attached page clearly identified as a continuation of the information in Item 1.
Enter a ch
eck mark in the "No" box, if no information is contained on an attached page.
2. Name, Address, Legal Entity Type, and Citizenship of Assignee.
3. Nature of Conveyance/Execution Date(s).
Enter the e
xecution date(s) of the document. It is preferable to use the name of the month, or an abbreviation of that
name, to minimize confusion over dates. In addition, place a check mark in the appropriate box describing the nature of the
conveying doc
ument. If the "Other" box is checked, specify the nature of the conveyance. The "Other" box should be
if the conveying/receiving party is correcting a previously filed document.
4. Application Number(s) or Registration Number(s).
ate the application number(s) including series code and serial number, and/or registration number(s) against
which the document is to be recorded. The identification of the trademark should be provided for all properties to avoid
recordation against the wrong property. A filing date should be provided only when the application or registration number is
unknown. 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.
5. Name and Address of Party to whom correspondence concerning document should be mailed.
Enter the name and full address of the party to whom correspondence is to be mailed.
6. Total Applications and Trademarks Involved.
Enter the t
otal number of applications and trademarks identified for recordation. Be sure to include all applications
and registrations identified on the cover sheet and on additional pages.
Item 7.
Total Fee Enclosed.
Enter the t
otal fee enclosed or authorized to be charged. A fee is required for each application and registration
which the document is recorded.
Item 8. Payment Information.
Enter the dep
osit account number and authorized user name to authorize charges.
9. Signature.
Enter the n
ame of the person submitting the document. The submitter must sign and date the cover sheet. Enter the
total n
umber of pages including the cover sheet, attachments, and document.
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
SPTO to process) patent and trademark assignment requests. After the USPTO records the information, the records for patent and trademarks, assignments,
nd other associated documents can be inspected by the public. To view documents recorded under secrecy orders or documents recorded due to the interest
of t
he 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
is burden, should be sent to the Manager of the Assignment Recordation Branch, Randolph Square, Room 5D01, 2800 South Randolph Street, Arlington, VA
22206. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Mail Stop Assignment Recordation Branch, Director of the
TO, P.O. Box 1450, Alexandria, VA 22313-1450.
Enter the name and complete address of the first party receiving the interest. If there is more than one receiving
party,check the "Yes" box to indicate that additional information is attached and write the wording “See additional sheet” on the
citizenship line. On a separate sheet, provide all of the necessary information about the other receiving parties, as explained
below. If the receiving party is an individual, check the “Individual” box and enter the citizenship of the receiving individual. If the
receiving party is a legal entity, i.e., corporation, association, limited partnership, etc., designate the legal entity and citizenship of
the receiving party by checking the appropriate box and filling in the citizenship information. If a box is not provided for the legal
entity, check the “Other” box and write the nature of the legal entity, e.g., limited liability company, trust, estate, etc., and its
citizenship. Information about the entity type and citizenship is mandatory.
The citizenship of a legal entity is as follows: for a corporation, it is the U.S. state (or foreign country) of incorporation; for
an association, it is the U.S. state (or foreign country) under which it is organized; for a partnership or joint venture, it is the U.S.
state (or foreign country) under which it is organized, etc. In addition, for a domestic partnership or domestic joint venture, the
cover sheet must include the names, legal entities, and national citizenship (or the state or country of organization) of all general
partners or active members that compose the domestic partnership or domestic joint venture. For a trust or estate, the same
information should be provided. If additional space is needed, check the "Yes" box to indicate that additional information is
attached, write the wording “See additional sheet” next to the appropriate entity designation, and provide the required information
on the additional sheet.
If the receiving party is not domiciled in the United States, a designation of domestic representative is encouraged. Check
the appropriate box to indicate whether or not a designation of domestic representative is attached. Check the "No" box if no
information is attached.
missions, including investigating potential violations of law or contract and awarding contracts
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 authoriz
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
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.