Change of Address (electronic submission)

UNITED STATES PATENT AND TRADEMARK OFFICE
Expiration 09/30/2014

CHANGE OF ADDRESS
FOR
REGISTERED PATENT ATTORNEYS AND AGENTS

Please use this form to update your correspondence/business and home addresses. The
correspondence/business address provided will be the only address posted in the Roster of Agents and
Attorneys, unless you indicate otherwise. This address update form must be signed by the attorney or agent and
include the registration number.
NAME (last, first, middle name or initial)

Registration/Recognition
Number (Required)

Mr.
Ms.

CORRESPONDENCE BUSINESS NAME (employer, corporation, law firm, or U.S. Government agency, etc.)

CORRESPONDENCE /
BUSINESS ADDRESS
(street, building, suite, etc.)

CITY

STATE

BUSINESS TELEPHONE

ZIP CODE

SECONDARY E-MAIL

PRIMARY E-MAIL

HOME
ADDRESS
CITY

STATE

HOME TELEPHONE

ZIP CODE

This address change is for the roster of Attorneys and Agents and will not change the address of any applications
in the patent process.
Note: U.S. Government employees must list their agency address as their correspondence address.
If you have any questions regarding your address of record in the Office of Enrollment and Discipline, please call
(571) 272-4097)
Mail completed form to: Mail Stop OED, Director, United States Patent and Trademark Office
P.O. Box 1450, Alexandria, VA 22313-1450

Signature of Registered Attorney or Agent (Required)

Date

PRIVACY ACT ADVISORY STATEMENT
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with the request for information solicited on
attached forms PTO-158, PTO-275 and PTO-1209. Accordingly, pursuant to the requirements of the Act, please be advised that (i) the
authority for the collection of this data is 35 U.S.C. §§ 1 and 2(b)(2)(D), (ii) furnishing of the information solicited is voluntary, and (iii) the
principal purpose for which the data will be used is to maintain current information relating to your eligibility and fitness for recognition to
practice before the United States Patent and Trademark Office in patent matters. If you do not furnish the requested information, you will not
be admitted to the registration examination, recognized or reinstated to practice in patent matters before the United States Patent and
Trademark Office.
The information provided by you in this form will be subject to the following routine uses:
1.

Information from PTO-158 may be published by the United States Patent and Trademark Office in the Official Gazette to solicit
information tending to affect your eligibility on moral, ethical, or other grounds for recognition pursuant to 37 CFR §§ 11.7 and/or 11.9.
Information from PTO-275 may be published to provide the public with a roster of registered practitioners pursuant to 37 CFR § 11.11.

2.

Disclosure may be made to any Government agency, professional organization, or individual if necessary to obtain information relevant
to an investigation concerning the suitability of an applicant for registration to practice before the United States Patent and Trademark
Office.

3.

Disclosure may be made to a Federal, state, local, foreign, tribal, or other public authority, of the fact that this system of records contains
information relevant to the retention of an employee, retention of a security clearance, the letting of a contract, or the issuance or
retention of a license, grant, or other benefit. The other agency or licensing organization may then make a request supported by the
written consent of the individual for the entire record if it so chooses. No disclosure will be made unless the information has been
determined to be sufficiently reliable to support a referral to another office within the agency, or to another Federal agency for criminal,
administrative, personnel, or regulatory action.

4.

Disclosure may be made to a court or adjudicative body in a proceeding when: (a) the agency or any component thereof; or (b) any
employee of the agency in his or her capacity; or (c) any employee of the agency in his or her official capacity where the agency has
agreed to represent the employee; or (d) the United States Government, is a party to litigation or has an interest in such litigation, and
by careful review, the agency determines that the records are both relevant and necessary to the litigation and the use of such records
is therefore deemed by the agency to be for a purpose that is compatible with the purpose for which the agency collected the records.

5.

Disclosure may be made to a member of Congress or to a congressional staff member in response to an inquiry of the Congressional
office made at the written request of the constituent about whom the record is maintained.

6.

Information may be disclosed to the Office of Management and Budget (OMB) in connection with a review of private relief legislation (as
set forth in OMB Circular No. A-19) at any stage of the legislative coordination and clearance process described in the Circular.

7.

The information may be disclosed to the agency contractors, grantees, experts, consultants or volunteers who have been engaged by
the agency to assist in the performance of a service related to this system of records and who have need to have access to the records
in order to perform the activity. 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).

8.

The information may be disclosed to the Office of Personnel Management (OPM) for personnel research purposes as a data source for
management information, for the production of summary descriptive statistics and analytical studies in support of the function for which
the records are collected and maintained, or for related manpower studies.

9.

Records from this system of records may be disclosed to the National Archives and Records Administration or to the General Services
Administration for records management inspections conducted under 44 U.S.C. §§ 2904 and 2906.

10.

When a record on its face, or in conjunction with other records, indicates a violation or potential violation of law, whether civil, criminal,
or regulatory in nature, and whether arising by general statute or particular program statute, or by regulation, rule or order, issued
pursuant thereto, disclosure may be made to the appropriate agency, whether Federal, foreign, state, local or tribal, or other public
authority responsible for enforcing, investigating, or prosecuting violations, or charged with enforcing or implementing the statute or rule,
regulation or order issued pursuant thereto, if the information disclosed is relevant to any enforcement, regulatory, investigative, or
prospective responsibility of the receiving entity.