PTO/SB/123 (01-06)
Approved for use through 12/31/2008. 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.
Patent Number
Issue Date
Application Number
Filing Date
First Named Inventor
CHANGE OF
CORRESPONDENCE ADDRESS
Patent
Address to:
Mail Stop Post Issue
Commissioner for Patents
P.O. Box 1450
Alexandria, VA 22313-1450
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.
Assignee of record of the entire interest. See 37 CFR 3.71.
Statement under 37 CFR 3.73(b) is enclosed. (Form PTO/SB/96).
Attorney or agent of record. Registration Number ______________________.
Signature
Typed or
Printed Name
Date
Telephone
NOTE: Signatures of all the inventors or assignees of record of the entire interest or their representative(s) are required. 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 informa