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PATENT - POWER OF ATTORNEY OR REVOCATION OF (USPTO)

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PTO/AIA/81A (02-15)
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
I hereby revoke all previous powers of attorney given in the above-identified patent.
A Power of Attorney is submitted herewith.
I hereby appoint Practitioner(s) associated with the Customer Number identified in the box at right as my/our
attorney(s) or agent(s) with respect to the patent identified above, and to transact all business in the United
States Patent and Trademark Office connected therewith:
I hereby appoint Practitioner(s) named below as my/our attorney(s) or agent(s) with respect to the patent 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 patent to:
The address associated with the above-identified Customer Number.
The address associated with the Customer Number identified in the box at right:
Firm or
Individual Name
Address
City
State
Country
Telephone
Email
I am the:
Applicant.
Patent owner.
Statement under 37 CFR 3.73(c) (Form PTO/AIA/96) submitted herewith or filed on __________________________________.
SIGNATURE of
Applicant
or Patent Owner
Signature
Date
Name
Telephone
Title and Company
NOTE: Signatures of all the applicants or patent owners of the entire interest or their representative(s) are required. If more than one signature
is required, submit multiple forms, check the box below, and identify the total number of forms submitted in the blank below.
A total of __________________ forms are submitted.
This collection of information is required by 37 CFR 1.31, 1.32, and 1.33. The information is required to obtain or retain a benefit by the public, which is to update
(and by the USPTO to process) the file of a patent or reexamination proceeding. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 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: 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.
PATENT - POWER OF ATTORNEY
OR
REVOCATION OF POWER OF ATTORNEY
WITH A NEW POWER OF ATTORNEY
AND
CHANGE OF CORRESPONDENCE ADDRESS
Patent
Number
Issue
Date
First Named Inventor
Title
Attorney
Docket
No.
OR
OR
OR
OR
OR
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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Completed 17 July 2021

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