PTO/AIA/81A Patent – Power of Attorney or Revocation of Power of Att

PTO/AIA/81A (02-15)
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U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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PATENT - POWER OF ATTORNEY
OR
REVOCATION OF POWER OF ATTORNEY
WITH A NEW POWER OF ATTORNEY
AND
CHANGE OF CORRESPONDENCE ADDRESS

Patent Number
Issue Date
First Named Inventor
Title

Attorney Docket No.

I hereby revoke all previous powers of attorney given in the above-identified patent.
A Power of Attorney is submitted herewith.
OR

I hereby appoint Practitioner(s) associated with the Customer Number identified in the box at right as my/our
attorney(s) or agent(s) with respect to the patent 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) with respect to the patent 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 patent to:
The address associated with the above-identified Customer Number.
OR

The address associated with the Customer Number identified in the box at right:
OR
Firm or
Individual Name
Address

City
Country
Telephone

State

Zip

Email

I am the:
Applicant.
OR

Patent owner.
Statement under 37 CFR 3.73(c) (Form PTO/AIA/96) submitted herewith or filed on __________________________________.
SIGNATURE of Applicant or Patent Owner

Signature
Name
Title and Company

Date
Telephone

NOTE: Signatures of all the applicants or patent owners of the entire interest or their representative(s) are required. If more than one signature
is required, submit multiple forms, check the box below, and identify the total number of forms submitted in the blank below.
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