Fillable Printable Revocation of Power of Attorney - Virginia

Revocation of Power of Attorney - Virginia

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

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 depend

ing 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:

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

sig

nature is re

uired

see below*.

*Total of ____________ forms are submitted.

A Power of Attorney is submitted herewith.

The address associated with the above-mentioned Customer Number.

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