Fillable Printable Power of Attorney and Revocation of Power of Attorney Form

Power of Attorney and Revocation of Power of Attorney Form

PTO/SB/81 (01-09)

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.

POWER OF ATTORNEY

Application Number

Filing Date

REVOCATION OF POWER OF ATTORNEY

WITH A NEW POWER OF ATTORNEY

AND

CHANGE OF CORRESPONDENCE ADDRESS

First Named Inventor

Title

Art Unit

Examiner Name

Attorney Docket Number

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:

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:

The address associated with Customer Number:

Firm or

Individual Name

Address

City

State

Zip

Country

Telephone

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.

A Power of Attorney is submitted herewith.

The address associated with the above-mentioned Customer 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.

Privacy Act Statement

The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with

your submission of the attached form related to a patent application or patent. Accordingly, pursuant to

the requirements of the Act, please be advised that: (1) the general authority for the collection of this

information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary; and (3) the

principal purpose for which the information is used by the U.S. Patent and Trademark Office is to process

and/or examine your submission related to a patent application or patent. If you do not furnish the

requested information, the U.S. Patent and Trademark Office may not be able to process and/or examine

your submission, which may result in termination of proceedings or abandonment of the application or

expiration of the patent.

The information provided by you in this form will be subject to the following routine uses:

1. The information on this form will be treated confidentially to the extent allowed under the

Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records

from this system of records may be disclosed to the Department of Justice to determine

whether disclosure of these records is required by the Freedom of Information Act.

2. A record from this system of records may be disclosed, as a routine use, in the course of

presenting evidence to a court, magistrate, or administrative tribunal, including disclosures

to opposing counsel in the course of settlement negotiations.

3. A record in this system of records may be disclosed, as a routine use, to a Member of

Congress submitting a request involving an individual, to whom the record pertains, when

the individual has requested assistance from the Member with respect to the subject matter

of the record.

4. A record in this system of records may be disclosed, as a routine use, to a contractor of the

Agency having need for the information in order to perform a contract. Recipients of

information shall be required to comply with the requirements of the Privacy Act of 1974, as

amended, pursuant to 5 U.S.C. 552a(m).

5. A record related to an International Application filed under the Patent Cooperation Treaty in

this system of records may be disclosed, as a routine use, to the International Bureau of

the World Intellectual Property Organization, pursuant to the Patent Cooperation Treaty.

6. A record in this system of records may be disclosed, as a routine use, to another federal

agency for purposes of National Security review (35 U.S.C. 181) and for review pursuant to

the Atomic Energy Act (42 U.S.C. 218(c)).

7. A record from this system of records may be disclosed, as a routine use, to the

Administrator, General Services, or his/her designee, during an inspection of records

conducted by GSA as part of that agency’s responsibility to recommend improvements in

records management practices and programs, under authority of 44 U.S.C. 2904 and 2906.

Such disclosure shall be made in accordance with the GSA regulations governing

inspection of records for this purpose, and any other relevant (i.e., GSA or Commerce)

directive. Such disclosure shall not be used to make determinations about individuals.

8. A record from this system of records may be disclosed, as a routine use, to the public after

either publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent

pursuant to 35 U.S.C. 151. Further, a record may be disclosed, subject to the limitations of

37 CFR 1.14, as a routine use, to the public if the record was filed in an application which

became abandoned or in which the proceedings were terminated and which application is

referenced by either a published application, an application open to public inspection or an

issued patent.

9. A record from this system of records may be disclosed, as a routine use, to a Federal,

State, or local law enforcement agency, if the USPTO becomes aware of a violation or

potential violation of law or regulation.