PTO/AIA/81A Power of Attorney or Revocation of Power of Attorney wit

PTO/AIA/81A (02-15)
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

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.
A total of __________________ forms are submitted.
This collection of information is required by 37 CFR 1.36. 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
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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