Form Pto/sb/57 - Request For Ex Parte Reexamination Transmittal Form

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PTO/SB/57 (01-18)
Approved for use through 09/30/2018. OMB 0651-0064
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.
(Also referred to as FORM PTO-1465)
REQUEST FOR EX PARTE REEXAMINATION TRANSMITTAL FORM
Address to:
Mail Stop Ex Parte Reexam
Commissioner for Patents
Attorney Docket No.:_________________
P.O. Box 1450
Alexandria, VA 22313-1450
Date:______________________
1.
This is a request for ex parte reexamination pursuant to 37 CFR 1.510 of patent number _________________
issued ________________________. The request is made by:
patent owner.
third party requester.
2.
The name and address of the person requesting reexamination is:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
3.
Requester
asserts small entity status (37 CFR 1.27) or
certifies micro entity status (37 CFR 1.29). Only
a patent owner requester can certify micro entity status. Form PTO/SB/15A or B must be attached to certify
micro entity status.
4.
This request is accompanied by payment of the reexamination fee as set forth in:
37 CFR 1.20(c)(2); or
37 CFR 1.20(c)(1). In checking this box for payment of the fee set forth in 37 CFR 1.20(c)(1), requester
asserts that this request has forty (40) or fewer pages and complies with all other requirements of
37 CFR 1.20(c)(1).
Payment of the reexamination fee is made by the method set forth below.
a.
A check in the amount of $_______________ is enclosed to cover the reexamination fee;
b.
The Director is hereby authorized to charge the reexamination fee
to Deposit Account No. ________________________;
Payment by credit card. Form PTO-2038 is attached; or
c.
d.
Payment made via EFS-Web.
In addition, the Director is hereby authorized to charge any fee deficiencies to
Deposit Account No. ________________________.
5.
Any refund should be made by
check or
credit to Deposit Account No.__________________.
37 CFR 1.26(c). If payment is made by credit card, refund must be to credit card account.
6.
A copy of the patent to be reexamined having a double column format on one side of a separate paper is
enclosed. 37 CFR 1.510(b)(4).
7.
CD-ROM or CD-R in duplicate, Computer Program (Appendix) or large table
Landscape Table on CD
[Page 1 of 3]
This collection of information is required by 37 CFR 1.510. The information is required to obtain or retain a benefit by the public which is to file (and by the USPTO
to process) a request for reexamination. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 18 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
SEND TO: Mail Stop Ex Parte Reexam, Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
THIS ADDRESS.
If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

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