PTO-1595 Recordation Form Cover Sheet - Patents Only

U.S. DEPARTMENT OF COMMERCE
United States Patent and Trademark Office

Form PTO-1595 (Rev. 6-18)
OMB No. 0651-0027 (exp. XX/XX/XXXX)

RECORDATION FORM COVER SHEET

PATENTS ONLY
To the Director of the U.S. Patent and Trademark Office: Please record the attached documents or the new address(es) below.

1. Name of conveying party(ies)

2. Name and address of receiving party(ies)
Name:
Internal Address:

Additional name(s) of conveying party(ies) attached?

Yes

No

Street Address:

3. Nature of conveyance/Execution Date(s):
Execution Date(s)
Assignment

Merger

Security Agreement

Change of Name

Joint Research Agreement

City:
State:

Government Interest Assignment

Country:

Executive Order 9424, Confirmatory License

Other

Zip:

Additional name(s) & address(es) attached?

4. Application or patent number(s):

Yes

No

This document serves as an Oath/Declaration (37 CFR 1.63).
B. Patent No.(s)

A. Patent Application No.(s)

Additional numbers attached?

5. Name and address to whom correspondence
concerning document should be mailed:
Name:

Yes

No

6. Total number of applications and patents
involved:

7. Total fee (37 CFR 1.21(h) & 3.41)

$

Internal Address:
Authorized to be charged to deposit account
Enclosed

Street Address:

None required (government interest not affecting title)
8. Payment Information

City:

Zip:

State:
Phone Number:

Deposit Account Number

Docket Number:
Authorized User Nam e

Email Address:_
9. Signature:
Signature
Name of Person Signing

Date
Total number of pages including cover
sheet, attachments, and documents:

Documents to be recorded (including cover sheet) should be faxed to (571) 273-0140, or mailed to:
Mail Stop Assignment Recordation Services, Director of the USPTO, P.O.Box 1450, Alexandria, V.A. 22313-1450

Guidelines for Completing Patents Cover Sheets
(PTO-1595)
Cover Sheet information must be submitted with each document to be recorded. If the document to be
recorded concerns both patents and trademarks separate patent and trademark cover sheets, including any attached
pages for continuing information, must accompany the document. All pages of the cover sheet should be numbered
consecutively, for example, if both a patent and trademark cover sheet is used, and information is continued on one
additional page for both patents and trademarks, the pages of the cover sheet would be numbered from 1
to 4.
Item 1. Name of Conveying Party(ies).
Enter the full name of the party(ies) conveying the interest. If there is insufficient space, enter a check mark
in the "Yes" box to indicate that additional information is attached. The name of the additional conveying party(ies)
should be placed on an attached page clearly identified as a continuation of the information Item 1. Enter a check mark
in the "No" box, if no information is contained on an attached page. If the document to be recorded is a joint research
agreement, enter the name(s) of the party(ies) other than the owner of the patent or patent application as the conveying
party(ies).
Item 2. Name and Address of Receiving Party(ies).
Enter the name and full address of the first party receiving the interest. If there is more than one party
receiving the interest, enter a check mark in the "Yes" box to indicate that additional information is attached. Enter a
check mark in the "No" box, if no information is contained on an attached page. If the document to be recorded is a
joint research agreement, enter the name(s) of the patent or patent application owner(s) as the receiving party.
Item 3. Nature of Conveyance/Execution Date(s).
Enter the execution date(s) of the document. It is preferable to use the name of the month, or an abbreviation
of that name, in order that confusion over dates is minimized. Place a check mark in the appropriate box describing the
nature of the conveying document. If the "Other" box is checked, specify the nature of the conveyance.
Item 4. Application Number(s) or Patent Number(s).
Indicate the application number(s), and/or patent number(s) against which the document is to be recorded.
National application numbers must include both the series code and a six-digit number (e.g., 07/123,456), and
international application numbers must be complete (e.g., PCT/US91/12345).
Enter a check mark in the appropriate box: "Yes" or "No " if additional numbers appear on attached pages.
Be sure to identify numbers included on attached pages as the continuation of Item 4. Also enter a check mark if this
Assignment is being filed as an Oath/Declaration ( 37 CFR 1.63).
Item 5. Name and Address of Party to whom correspondence concerning the document should be
mailed. Enter the name and full address of the party to whom correspondence is to be mailed.
Item 6. Total Applications and Patents involved.
Enter the total number of applications and patents identified for recordation. Be sure to include all
applications and patents identified on the cover sheet and on additional pages.
Block 7. Total Fee Enclosed.
Enter the total fee enclosed or authorized to be charged. A fee is required for each application and patent
against which the document is recorded.
Item 8. Payment Information.
Enter the deposit account number and authorized user name to authorize charges.
Item 9. Signature.
Enter the name of the person submitting the document. The submitter must sign and date the cover sheet.
Enter the total number of pages including the cover sheet, attachments, and document.
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with
an information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a valid OMB Control
Number. The OMB Control Number for this information collection is 0651-0027. Public burden for this form is estimated to average 40 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing
this burden to the Office of the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or
email [email protected]. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Mail Stop Assignment
Recordation Services, Director of the USPTO, P.O. Box 1450, Alexandria, VA 22313-1450.

Privacy Act Statement for Patent Assignment Recordation Form Cover Sheet
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in
connection with the above request for information. This collection of information is authorized
by 35 U.S.C. 1, 2, 261 and E.O. 9424. This information will primarily be used by the USPTO
for the recordation of assignments related to patents and patent applications. Submission of this
information is voluntary but is required in order for the USPTO to record the requested
assignment. If you do not provide the information required on the cover sheet, the assignment
will not be recorded, and all documents will be returned to you.

After the information is recorded, the records and associated documents can be inspected by the
public and are not confidential, except for documents that are sealed under secrecy orders or
related to unpublished patent applications. Assignment records relating to unpublished patent
applications are maintained in confidence in accordance with 35 U.S.C. 122.
Records open to
the public are searched by users for the purpose of determining ownership for other property
rights with respect to patents and trademarks.
Routine uses of the information you provide may also include disclosure to appropriate Federal,
state, local, or foreign agencies in support of their enforcement duties and statutory or regulatory
missions, including investigating potential violations of law or contract and awarding contracts
or other benefits; to a court, magistrate, or administrative tribunal in the course of presenting
evidence; to members of Congress responding to requests for assistance from their constituents;
to the Office of Management and Budget in connection with the review of private relief
legislation; to the Department of Justice in connection with a Freedom of Information Act
request; to a contractor in the performance of their duties; to the Office of Personnel
Management for personnel studies; and to the General Services Administration (GSA) as part of
their records management responsibilities under the authority of 44 U.S.C. 2904 and 2906. Such
disclosure to GSA shall not be used to make determinations about individuals.