Form Pto/aia/122 - Change Of Correspondence Address Application

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PTO/AIA/122 (08-12)

Approved for use through 01/31/2018. 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.

Application Number

CHANGE OF

CORRESPONDENCE ADDRESS

Filing Date

Application

First Named Inventor

Art Unit

Address to:

Commissioner for Patents

Examiner Name

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:

Firm or

Individual Name

Address

City

State

Zip

Country

Telephone

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

Attorney or agent of record. Registration Number _____________________.

Registered practitioner named in the application transmittal papers who acts in a representative capacity

under 37 CFR 1.34. See 37 CFR 1.33(a)(1). Registration Number ______________________.

Signature

Typed or Printed

Name

Telephone

Date

NOTE: This form must be signed in accordance with 37 CFR 1.33. See 37 CFR 1.4(d) for signature requirements and certifications.

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 information is required to obtain or retain a benefit by the public which is to file (and by the USPTO

to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 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

Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450

ADDRESS. SEND TO:

If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.