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USPTO Power of Attorney Revocation Form


USPTO Power of Attorney Revocation Form
USPTO Power of Attorney Revocation Form
PTO/SB/81 (11-08)
Approved for use through 11/30/2011. 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
Filing Date
First Named Inventor
Title
Art Unit
Examiner Name
POWER OF ATTORNEY
OR
REVOCATION OF POWER OF ATTORNEY
WITH A NEW POWER OF ATTORNEY
AND
CHANGE OF CORRESPONDENCE ADDRESS
Attorney Docket Number
This collection of information is required by 37 CFR 1.31, 1.32 and 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
ADDRESS. SEND TO:
Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.
I hereby revoke all previous powers of attorney given in the above-identified application.
I hereby appoint Practitioner(s) associated with the following Customer
Number as my/our attorney(s) or agent(s) to prosecute the application
identified above, and to transact all business in the United States Patent
and Trademark Office connected therewith:
OR
I hereby appoint Practitioner(s) named below as my/our attorney(s) or agent(s) to prosecute the application identified above, and
to transact all business in the United States Patent and Trademark Office connected therewith:
Practitioner(s) Name Registration Number
Please recognize or change the correspondence address for the above-identified application to:
OR
The address associated with Customer Number:
Firm or
Individual Name
Address
City
State
Zip
Country
Telephone
Email
I am the:
Applicant/Inventor.
Assignee of record of the entire interest. See 37 CFR 3.71.
Statement under 37 CFR 3.73(b) (Form PTO/SB/96) submitted herewith or filed on ______________________________.
SIGNATURE of Applicant or Assignee of Record
Signature
Date
Name
Telephone
Title and Company
NOTE: Signatures of all the inventors or assignees of record of the entire interest or their representative(s) are required. Submit multiple forms if more than one
signature is required, see below*.
*Total of ____________ forms are submitted.
OR
A Power of Attorney is submitted herewith.
The address associated with the above-mentioned Customer Number.
OR
OR
Print Form
USPTO Power of Attorney Revocation Form
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