PTO/AlA/80 (07-12)
`Approved for use through 11/30/2014. OMB 0651-0035
`U.S. Patent and Trademark Office; US 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.
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`POWER OF ATTORNEY TO PROSECUTE APPLICATIONS BEFORE THE USPTO
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`I hereby appoint:
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`1 O7O75
`gazitioners associatedwith CustomerNumber:
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`D Practitioner(s) named below (if more than ten patent practitioners are to be named, then a customer number must be used):
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`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 assignments documents
`attached to this form in accordance with 37 CFR 3.73(c).
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`Please change the correspondence address for the application identified in the attached statement under 37 CFR 3.73(c) to:
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`The address associated with Customer Number:
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`1 07075
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`¢
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`'3'
`OR
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`Firm or
`Individual Name
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`Telephone
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`Assignee Name and Address: Theranos, Inc.
`1601 8. California Ave
`Palo Alto, CA 94304
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`A copy of this form, together with a statement under 37 CFR 3.73(c) (Form PTO/AlA/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.
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`The individual whose sion-
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`SIGNATURE of Assignee of Record
`re and title is supplied below is authorized to act on behalf of the assignee
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`Signature
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`Name
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`Date
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`Telephone
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`(650) 838-9292
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`This collection of information is required by 37 CFR 1.31, 1.32 and 1.33. 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 collection is estimated to take 3 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 Chief information Officer,
`US Patent and Trademark Office, US. Department of Commerce, 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.
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`If you need assistance in completing the form, call 1—800-PTO—9199 and select option 2.
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