Form Pto/sb/57 - Request For Ex Parte Reexamination Transmittal Form Page 3
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4PTO/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.
17.
Correspondence Address: Direct all communication about the reexamination to:
The address associated with Customer Number:
OR
Firm or Individual Name ____________________________________________________________________
(at the address identified below)
Address
City
State
Zip
Country
Telephone
Email
18.
The patent is currently the subject of the following concurrent proceeding(s):
a.
Copending reissue Application No.
______________________________________________
b.
Copending reexamination Control No. ______________________________________________
c.
Copending Interference No.
______________________________________________
d.
Copending litigation styled:
____________________________________________________________________________
____________________________________________________________________________
WARNING : Information on this form may become public. Credit card information should not be included on this
form. Provide credit card information and authorization on PTO-2038.
__________________________________________________
___________________________
Authorized Signature
Date
__________________________________________________
___________________________
Typed/Printed Name
Registration No.
For Patent Owner Requester
For Third Party Requester
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