PTO/SB/122 (01-06)
Approved for use through 12/31/2008. OMB 0651-0035
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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Application Number
Filing Date
First Named Inventor
Art Unit
Examiner Name
CHANGE OF
CORRESPONDENCE ADDRESS
Application
Address to:
Commissioner for Patents
P.O. Box 1450
Alexandria, VA 22313-1450
Attorney Docket Number
Please change the Correspondence Address for the above-identified patent application 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).
I am the:
Applicant/Inventor
Assignee of record of the entire interest.
Statement under 37 CFR 3.73(b) is enclosed. (Form PTO/SB/96).
Attorney or agent of record. Registration Number _____________________.
Registered practitioner named in the application transmittal letter in an application without an
executed oath or declaration. See 37 CFR 1.33(a)(1). 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 representa