PTO/AIA/80 Power of Attorney to Prosecute Applications Before the U

PTO/AIA/80 (07-17)
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 person is required to respond to a collection of information unless it displays a valid OMB control number

POWER OF ATTORNEY TO PROSECUTE APPLICATIONS BEFORE THE USPTO
I hereby revoke all previous powers of attorney given in the application identified in the attached
statement under 37 CFR 3.73(c).
I hereby appoint:
Practitioners associated with Customer Number:

OR
Practitioner(s) named below (if more than ten patent practitioners are to be named, then a customer number must be used):
Name

Registration
Number

Registration
Number

Name

As attorney(s) or agent(s) to represent the undersigned before the United States Patent and Trademark Office (USPTO) in connection with
any and all patent applications assigned only to the undersigned according to the USPTO assignment records or assignment documents
attached to this form in accordance with 37 CFR 3.73(c).

Please change the correspondence address for the application identified in the attached statement
under 37 CFR 3.73(c) to:
The address associated with Customer Number:

OR
Firm or individual name
Address
City

State

Zip

Country
Telephone

Email

Assignee name and address:
A copy of this form, together with a statement under 37 CFR 3.73(c) (Form PTO/AIA/96 or equivalent) is required to be
filed in each application in which this form is used. The statement under 37 CFR 3.73(c) may be completed by one of the
practitioners appointed in this form, and must identify the application in which this Power of Attorney is to be filed.
SIGNATURE of Assignee of Record
The individual whose signature and title is supplied below is authorized to act on behalf of the assignee.

Signature

Date

Name

Telephone

Title
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 update (and
by the USPTO to process) the file of a patent or reexamination proceeding. 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 (SORN) 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 (FOIA) assistance; to members
of congress working on behalf of an individual; to the Office of Personnel Management (OPM) for personnel research
purposes; to National Archives and Records Administration for inspection of records; and to the Office of Management
and Budget (OMB)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