PTO/SB/47 (03-09)
`Approved for use through 05/31/2015. OMB 0651-0016
`U.S. Patent and Trademark Office; U. S. DEPARTMENT OF COMMERCE
`Underthe Paperwork Reduction Act of 1995, no persons are required to respondto a collection of information unlessit displays a valid OMB control number.
`
`“FEE ADDRESS” INDICATION FORM
`
`Addressto:
`Mail Stop M Correspondence
`Commissionerfor Patents
`P.O. Box 1450
`Alexandria, VA 22313-1450
`
`Fax to:
`571-273-6500
`
`Forthe following listed application(s), please recognize as the “Fee Address” underthe provisions of 37 CFR
`1.363 the address associated with:
`
`Customer Number: 94740
`
`OR
`
`The attached Request for Customer Number (PTO/SB/125) form.
`[|
`
`PATENT NUMBER
`APPLICATION NUMBER
`
`(if known)
`
`08/87 1,560
`
`
`
`Completed by (check one):
`L Applicant/Inventor
`
`In addition,
`INSTRUCTIONS: Theissue fee must have been paid for application(s) listed on this form.
`only an address represented by a Customer Numbercan be established as the fee address for maintenance
`fee purposes (hereafter, fee address). A fee address should be established when correspondencerelated to
`maintenance fees should be mailed to a different address than the correspondence addressfor the application.
`Whento checkthefirst box below:If you have a Customer Numberto represent the fee address. When
`to check the second box below:If you have no Customer Numberrepresenting the desired fee address,
`in which case a completed Request for Customer Number (PTO/SB/125) must be attachedto this form. For
`more information on Customer Numbers, see the Manual of Patent Examining Procedure (MPEP)§ 403.
`
`forms are submitted.
`
`Attorney or Agentof record 62,319
`(Reg. No.)
`[| Assigneeof record ofthe entire interest. See 37 CFR 3.71.
`Statement under 37 CFR 3.73(b) is enclosed.
`(Form PTO/SB/96)
`
`L] Assignee recorded at Reel
`
`Frame
`
`Signature
`
`Michelle E. Dawson
`Typed orprinted name
`612-604-6391
`Requester’s telephone number
`
`ZU / /
`
`Date
`
`NOTE:Signaturesofall the inventors or assigneesof record of the entire interestor their representative(s) are required. Submit multiple formsif more that one
`signature is required, see below*.
`
`* Total of
`Cc]
`This collection of information is required by 37 CFR 1.363. The information is required to obtain or retain a benefit by the public whichistofile (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 collection is estimated to take 5 minutes to complete,
`including gathering, preparing, and submitting the completed application form to the USPTO.Timewill vary depending upon the individual case. Any comments on
`the amountof time you require to completethis form and/or suggestionsfor reducing this burden, should be sent to the Chief Information Officer, U.S. Patent and
`Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alex andria, VA 22313- 1450. DO NOT SEND COMPLETE D FORMSTO THIS A DDRESS.
`SEND TO: Mail Stop M Correspondence, Commissionerfor Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
`if you need assistance in completing the form, call 1-800-PTO-9199 and selectoption 2.
`
`