Form Pto/aia/123 - Change Ofcorrespondence Addresspatent - 2012

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Doc Code:
PTO/AIA/123 (08-12)
Approved for use through 11/30/2014. 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
CHANGE OF
Issue Date
CORRESPONDENCE ADDRESS
Application Number
Patent
Filing Date
Address to:
Mail Stop Post Issue
First Named Inventor
Commissioner for Patents
P.O. Box 1450
Attorney Docket
Alexandria, VA 22313-1450
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.
If the Patentee was not the applicant for patent (37 CFR 1.42), then a Statement under 37 CFR 3.73(c)
(Form PTO/AIA/96 or equivalent) is enclosed or was filed on __________________. See 37 CFR 3.71.
Attorney or agent of record. Registration Number _____________________.
Patent practitioner acting in a representative capacity whose correspondence address is the correspondence
address of record. Notice has been given to the patentee or owner. Registration Number ____________________.
Signature
Typed or
Printed Name
Date
Telephone
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
SEND TO: Mail Stop Post Issue, Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450
ADDRESS.
.
If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

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