Fillable Form Pto-1595 (Rev. 03-11) - Recordation Form Cover Sheet (Page 2 of 3) in pdf

G uidelines for Co m pleting P atents Cover Sheets

( P TO-1595)

Co v er Sheet in f or m ation m ust be sub m itted w ith each docu m ent to be recorded. If the d ocu m ent to b e

recorded concerns both patents a n d trade m arks separate patent and t rademark cover sheets, inclu d ing any attached

pages f or cont i nu i ng in f or m ation, m ust acco m pany the docu m ent. A ll pages of the cover sheet sho ul d be nu m bered

consecuti v el y , f or exa m ple, if both a patent and trade m ark cover sheet is used, and i n f or m ation is conti n ued on one

addit i onal pa g e f or both patents a nd tr a de m ar k s, the pa g es of the co v er sheet w ould be nu m bered f rom 1

to 4.

Item 1. Na m e o f Co nv eyi n g P a rty(ies).

Enter the f ull na m e of the part y (ies) con v e y ing the interest. If there is insu ff icient space, enter a check m ark

in t he "Yes" box to i ndicate that a ddit i onal in f or m ation is attached. T he name of the addit i onal con v e y ing part y (ies)

shou l d be placed on a n attached page clearly identi f ied as a continuation of the in f or m ation Item 1. E nter a check mark

in t he "No" box, if no i n f or m ation is contained on an attached page. If the do c u m ent to be reco r ded is a jo i nt research

a g reement, enter the na m e(s) of the part y (ies) other than the o w ner of the patent or patent a pplicat io n as the c o n v e y ing

part y (ies).

Item 2. Na m e and Ad d ress of Receivi n g P a rty(ies).

Enter the na m e and f ull address of the f irst party receiving the inte r est. If there is m ore than one par t y

receiving the interest, enter a ch e ck m ark in the "Yes" box t o i n di c ate that add i ti o nal i n f ormation is attached. Enter a

check m ark in the "No" bo x , if no in f or m ation is conta i ned on an a t tached page. If the docu m ent to be recorded is a

joint research agreement, enter t h e na m e(s) of the patent or patent applicat i on o w ner(s) as the receiving part y .

Item 3. N a t u re o f Con v eya n ce/Exec u ti o n D a te(s).

Enter the e x ecuti o n date(s) of the docu m ent. It is pre f erable to use t he na m e of the m onth, or an abb r e v iation

of that na m e, in o r der that con f usion o v er dates is m ini m ized. Place a check m ark in the appropriate box describ i ng the

nature of the con v e y ing docu m ent. If the "Other" box is c hecked, specify the nature of the con v e y ance.

Ite m 4 . A pp lic a tio n Nu m ber(s ) or P a te nt Nu m ber(s) .

Indicate the a pplicat i on nu m ber(s), and / or patent nu m ber(s) a g ainst w hich the d ocu m ent is to be rec o rded.

National a p plicati o n n u m bers m ust incl u de b oth the series code a n d a si x -di g it n u m ber (e. g ., 07 / 1 2 3 , 45 6 ), a n d

internat i onal a p plicati o n nu m bers m ust be co m plete (e. g ., PC T /US91 / 1 2 3 4 5).

Enter a check m ark in the approp r iate bo x : "Yes" or "No " if addi ti onal nu m bers appear on attached pages.

Be sure to i denti f y nu m bers included on attached pages as the cont i nuat i on of Item 4. A lso enter a check m ark if this

A ssi g n m ent is being f iled w ith a new application.

Item 5. Na m e and Ad d ress of P a rty to w h om c o rrespo n dence c o ncer n i n g the d o cu m e n t s h o u ld b e

m a ile d . Enter the na m e and f ull address o f the party to w hom correspond e n ce is to be m ailed.

Item 6. T o t a l Ap p lic a

i o ns a n d P a te n

s i n v o l v e d .

Enter the total nu m ber of applica t ions a n d patents i denti f ied f or recordat i on. Be sure to inc l ude all

applicati o ns a n d pate n ts ide n ti f ied o n t he co v er sheet and on add i t i onal pa g es.

Block 7. Total Fee E n close d .

Enter the total f ee enclosed or au t horized to be charged. A f ee is required f or each applicat i on a nd patent

a g ainst w hich the do c u m ent is recorded.

Item 8. P a y m e n t I n f o r m a ti on .

Enter the de p osit acco u nt nu m ber and autho r ized user na m e to au t horize charges.

Item 9. Sig na t u re.

Enter the na m e of the person s ub m itting the docu m ent. T he sub m itter m ust si g n and date t he co v er sheet.

Enter the total nu m ber of pa g es includ i ng the co v er sheet, attach m ents, a n d d ocu m ent.

Th i s col l ect i on of in f or m at i on i s r equi r ed by 35 USC 261 a n d 262 a n d 15 USC 1057 a n d 1060. T h e in f or m at i on i s u sed by t h e publ i c to s u b mit ( a n d b y

t h e USP T O t o p r ocess) pa t ent and tr ade m ark ass i gn m e n t r eq u es t s. A ft er t h e US PT O r eco r ds t h e i n f or m at i o n , t h e r eco r ds f or pa t ent a n d tr ade m a r ks,

ass i gn m e n t s, and ot h er assoc i a t ed docu m en t s can be i n spec t ed by t h e p u b l i c. T o v i ew docu m e n ts r eco r

ed u n der sec r ecy orde r s or docu m e n t s r eco r

d u e to t h e i n t e r es t o f t h e f e d e r a l g o v ern m e nt, a wr i tt e n a u t h or i zat i o n m u s t be s u b m i t t ed . T h i s co l l ect i o n i s est i m a t e d to t a ke 3 0 m i n u t e s t o co m p l e t e ,

i n cluding g at h erin g , preparing, a n d s u bmitting t h e form to t h e USPTO. Any com m ents on t h e a m ou n t of ti m e y ou require to co m p l e t e th i s f orm a n d/or

sug g est i o n s f or r ed u c i ng th i s bu r de n , s h ould be se n t to t h e Ma n a g er of t h e A ss i gn m e n t Div i s i o n , USPTO, P.O. B ox 1450, A l e x andr i a, VA 22313 - 1450.

DO NOT S END F E E S OR COMP L ET E D F ORMS T O TH I S A DDR E S S . SE ND T O: Mail S top A ss i gn m e n t Reco r dation S erv i ces, D i r ector of t h e

USP T O, P.O. B ox 1450, A l e x andr i a, VA 22313 - 1450.

Form Pto-1595 (Rev. 03-11) - Recordation Form Cover Sheet Page 2

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