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Form PTO-1595 (Rev. 6-18) OMB No. 0651-0027 (exp. 1 0/3 1 /202 4 )
U.S. DEPARTME NT OF COMMERCE United States Patent and Trademark Off ice
RECORDATION FORM COVER SHEET
P AT ENT S ONLY
To the Director of the U.S. Patent and Trademark Offi ce: Please record the attached documents or t he new address(es) below.
1. Name o f co n v eyi n g p ar ty (ies)
Additional name(s) of conveying party(ies) attached? Yes No
2. Name an d add ress o f recei v i n g p ar t y( ies)
Na m e:
Inte r nal Addr e ss :
St r eet Add r e ss :
Ci ty:
State:
Count r y: Z ip:
Addi tio nal na me(s) & addr es s (es) att ach ed? Ye s No
3. Nature of conveyance/Execution Date(s):
E x e c ution Date (s)
A ss ignm en t Me r ger
Se c u r i ty Ag r eem ent Change of Nam e
J oint Re s ea rc h Agr eem ent
Government Inter e st Ass ig nment
E x e c utive Or der 9424, Confi rm ator y L i c en s e
O the r
4. A ppli cation or p at ent numb er ( s): T his docu m ent serves as an Oath/Declaration (37 CFR 1.63).
A. Patent Appli c ation No. (s ) B. Patent No. (s )
Additional numbers attached? Yes No
5. Name and address to whom correspondence 6. Total number of applications and patents
concerning document should be mailed: involved:
Na m e: 7. Total fe e ( 37 CF R 1.21(h) & 3.41) $
Authori zed to be c har ged to depo s it a c count
En c lo s ed
None r equi r ed (go vern ment interest not aff ecti ng t i tle)
Inte r nal Add r ess :
St r eet Add r e ss :
Ci ty:
8. Pay m en t I nfo rmati o n
Depo s it A cc ount Nu m ber
Authori zed U s er Na m e
State: Z ip:
Phone Nu m be r :
Docket Number:
Em ail Add r ess:_
9. Signature:
Signatur e D ate
Total number of pages including cover
Na m e of Pers on Signing sheet, attachments, and documents:
D ocu me nt s t o be r ecor de d (inc l ud i n g co ver s heet) sh ou ld be f a xed to (571) 273-0140, or m ai l e d to: M ai l Stop Ass i g n me nt R ec or dati o n Ser vi c e s , D i r ec tor o f the USPT O , P. O.B ox 1 450 , A lex a n dr i a , V. A. 2 231 3- 14 50
Guidelines for Co mpleting Patents Cover Sheets (PTO-1595) Co ver Sheet inf orm ation m ust be subm itted w ith each docum ent to be recorded. If the docum ent to be recorded concerns both patents and tradem arks separate patent and t rademark cover sheets, including any attached pages f or continu ing inf orm ation, m ust acco m pany the docum ent. All pages of the cover sheet sho ul d be num 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 me of Co nveying P a rty(ies). Enter the f ull na m e of the party(ies) conveying the interest. If there is insuff icient space, enter a check m ark in t he "Yes" box to indicate that additional inf orm ation is attached. T he name of the additional conveying party(ies) should be placed on an attached page clearly identif ied as a continuation of the inf orm ation Item 1. E nter a check mark in t he "No" box, if no inf orm ation is contained on an attached page. If the do cum ent to be reco r ded is a jo int research a greement, enter the na m e(s) of the party(ies) other than the o w ner of the patent or patent application as the c o nveying party(ies).
Item 2. Na me and Ad dress of Receivi ng P a rty(ies). Enter the na m e and f ull address of the f irst party receiving the inter est. If there is m ore than one part y receiving the interest, enter a ch eck m ark in the "Yes" box t o indic ate that additi onal i nf ormation is attached. Enter a check m ark in the "No" bo x , if no inf orm ation is conta ined on an a t tached page. If the docum ent to be recorded is a joint research agreement, enter t he na m e(s) of the patent or patent application o w ner(s) as the receiving party.
Item 3. Na t ure of Con v eya nce/Exec uti on D a te(s). Enter the ex ecutio n date(s) of the docum ent. It is pref erable to use t he na m e of the m onth, or an abbr eviation of that na m e, in o r der that conf usion o ver dates is m inim ized. Place a check m ark in the appropriate box describ ing the nature of the convey ing docum ent. If the "Other" box is c hecked, specify the nature of the convey ance.
Ite m 4. A pplica 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 pplication num bers m ust inclu de both the series code an d a six -dig it num ber (e. g., 07/ 12 3 , 456 ), a nd international a p plicatio n num bers m ust be co m plete (e. g., PCT /US91/ 12 34 5). Enter a check m ark in the approp r iate bo x : "Yes" or "No " if additional num bers appear on attached pages. Be sure to i dentif y num bers included on attached pages as the continuat ion of Item 4. Also enter a check m ark if this Assi gn ment is being filed as an Oath/Declaration ( 37 CFR 1.63).
Item 5. Na me and Add ress of P a rty to w hom c orrespo n dence c oncern ing the d o cu m en t s ho uld be ma ile d. Enter the na m e and f ull address o f the party to w hom correspond en ce is to be m ailed.
Item 6. T ot a l Ap plica ti ons a nd P a te nts i nv ol ve d. Enter the total nu m ber of applica tions a n d patents i denti fied f or recordat i on. Be sure to inc l ude all applicati o ns a n d pate n ts ide n ti fied o n t he co v er sheet and on add i t i onal pa g es.
Block 7. Total Fee E nclose 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 gainst w hich the do c u m ent is recorded.
Item 8. Pa y m e n t Inf or ma ti on. Enter the deposit acco unt nu mber and author ized user name to au t horize charges.
Item 9. Signa t ure. Enter the na m e of the person s ubm 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 num ber of pa ges includi ng the co ver sheet, attach m ents, a nd docum ent.
Thi s col l ecti on of inf or m ati on i s r equi red by 35 USC 261 a n d 262 a n d 15 USC 1057 a n d 1060. T h e inf or m ati on i s u sed by t he publ ic to s u b mit ( a nd by the USP T O t o p r ocess) pa t ent and tr ade m ark assi gn m e n t req u es t s. A ft er t he US PT O r eco r ds th e i nf or mati o n, t he r eco r ds f or pa t ent a n d trade m a r ks, assi gn m e nt s, and oth er assoc i a t ed docu m ent s can be in spect ed by t he p u bli c. T o vi ew docu m e nts r eco rded u n der sec r ecy orde r s or docu m e nt s reco rd ed due to t he int e rest o f the fe d e r a l g o v ern m e nt, a writt e n a ut h or i zati o n mu st be s u b mi tt ed. T his co ll ecti o n is estim a t e d to t a ke 3 0 mi n ut e s to co m pl e t e , i n cluding gat herin 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 gesti o n s f or r ed u ci ng th i s bu r de n , s h ould be se nt to t he Ma n a g er of t he A ss i gn m e nt Divi si o n, USPTO, P.O. B ox 1450, Al 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 THI S ADDR E SS. SE ND T O: Mail S top A ssi gn m e nt Reco r dation S ervi ces, D irector of t he USP T O, P.O. B ox 1450, Al e xandr i a, VA 22313 - 1450.
