Pto Sb 466

Doc Code: TBD

Document Description: Transfer Cert Humanitarian Program

PTO/SB/466 (09-22)

Approved for use through 04/30/2025. OMB 0651-0066

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.

TRANSFER OF ACCELERATION CERTIFICATE UNDER THE PATENTS FOR HUMANITY PROGRAM Page 1 of 1
Certificate Number: ___________________________________________________________________
THE UNDERSIGNED HEREBY REQUESTS CONFIRMATION OF THE TRANSFER OF THE ABOVE-IDENTIFIED ACCELERATION CERTIFICATE AND STATES THE FOLLOWING: 1. The undersigned hereby authorizes the transfer of the above-identified acceleration certificate. 2. The above-identified certificate has not been redeemed. 3. It is understood that the decision whether to confirm the transfer of the above-identified certificate rests solely within the Director’s discretion and cannot be challenged before the USPTO. 4. There is no fee for this request. 5. Transferring party contact information:
Certificate owner: ____________________________________________________________________
Individual contact (if certificate owner is a juristic entity): ____________________________________
Address: ____________________________________________________________________________
City: _____________________________		State: ______________			Zip: _______________________
Country: ____________	Phone: ________________			Email: _______________________________
6. Receiving party contact information: Receiving party: ______________________________________________________________________ Individual contact (if receiving party is a juristic entity): ______________________________________ Address: ____________________________________________________________________________ City: _____________________________ State: ______________ Zip: _______________________ Country: ____________ Phone: ________________ Email: _______________________________
7. If sold for compensation, sale price (optional): ___________________________________________
The individual whose signature and title is supplied below is authorized to act on behalf of the certificate owner.
Signature			Date
Printed Name
Title
Phone			Email

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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 the information in this record under authority of 35 U.S.C. 2. The USPTO’s system of records is used to manage all applicant and owner information including name, citizenship, residence, post office address, and other information with respect to inventors and their legal representatives pertaining to the applicant's/owner’s activities in connection with the invention for which a patent is sought or has been granted. The applicable Privacy Act System of Records Notice for the information collected in this form is COMMERCE/PAT-TM-7 Patent Application Files, available in the Federal Register at 78 FR 19243 (March 29, 2013). https://www.govinfo.gov/content/pkg/FR-2013-03-29/pdf/2013-07341.pdf

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