Form PTO/AIA/81 Power of Attorney to One or More of The Joint Inventors

PTO/AIA/81 (07-12)
Approved for use through XX/XX/XXXX. OMB Control Number 0651-0035
U.S. Patent and Trademark Office; 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

POWER OF ATTORNEY TO ONE OR
MORE OF THE JOINT INVENTORS
AND CHANGE OF
CORRESPONDENCE ADDRESS

Filing Date
First Named Inventor
Art Unit
Examiner Name
Title

NOTE: This form may be filed by pro se inventors (i.e., prosecuting the application without a registered patent
practitioner) who are identified as the Applicant in the above-identified application. For a Power of Attorney to one
or more registered patent practitioners, see form PTO/AIA/82.
I hereby revoke all previous powers of attorney given in the above-identified application.
I hereby appoint the following joint inventor(s) to prosecute the application identified above, and
to transact all business in the United States Patent and Trademark Office connected therewith:

Please recognize or change the correspondence address for the above-identified application to:
The address associated with Customer Number. (if applicable):
-To Request A Customer Number see form PTO/SB/124

OR
Individual Name
Address
City

State

Zip

Country
Telephone

Email

I am the Inventor.
SIGNATURE of Inventor

Signature

Date

Name

Telephone

NOTE: Signatures of all the inventors are required. Submit multiple forms if more than one signature is required, see below*.

See 37 CFR 1.4 for signature

requirements and certifications.
*Total of

forms are submitted.
JRF

This collection of information is required by 37 CFR 1.31 and 1.32. 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 information collection is estimated to take
30 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 Office of
the Chief Administrative Officer, U.S. Patent and Trademark Office, 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. The United States Patent and Trademark
Office (USPTO) collects this information under authority of 37 CFR 1.31 and 1.32. This information is covered by a
System of Records Notice which identifies the categories of individuals covered by the system including inventors,
legal representatives for inventors, and other persons authorized by law to make applications for patent. The
information in this system of records is used to manage all records of applicants and legal representatives including
name, citizenship, residence, post office address and other information pertaining to activities in connection with the
invention for which a patent is sought.
The information obtain is protected from disclosure to third parties in accordance with the Privacy Act. However, routine
uses of this information may include disclosure to the following: to law enforcement and investigation in the event that
the system of records indicates a violation or potential violation of law; to a Federal, state, local, or international
agency, in response to its request; to an agency, organization, or individual for the purpose of performing audit or
oversight operations as authorized by law; to non-federal personnel under contract to the agency; to a court for
adjudication and litigation; to the Department of Justice for Freedom of Information Act assistance; to members of
congress working on behalf of an individual; to the Office of Personnel Management for personnel research purposes;
to National Archives and Records Administration for records management activities; and to the Office of Management
and Budget for legislative coordination and clearance. Failure to provide any part of the requested information may
result in an inability to process requests for access and information. The applicable Privacy Act System of Records
Notice for this information is COMMERCE/PAT-TM-7 Patent Application Files, available at Federal Register /Vol. 78,
No. 61 / Friday, March 29, 2013 /Notices 19243. https://www.govinfo.gov/content/pkg/FR-2013-03-29/
pdf/2013-07341.pdf