PTO/$8M? ((33419)
`Approved for use through 0781:2018. 0MB 0651-0016
`US. Patent and Trademark Office; U. 8. DEPARTMENT OF COMMERCE
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`“FEE ADDRESS” tNDlCATlON FORM
`
`Address to:
`
`Mail Stop M Correspondence
`Commissioner for Patents
`PO. Box 1450
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`Fax to:
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`571-273-5500
`
`Alexandria, VA 22313-1450
`
`In addition
`INSTRUCTlONS: The issue fee must have been paid for application(s) listed on this form.
`only an address represented by a Customer Number can be established as the fee address for maintenance
`fee purposes (hereafter, fee address). A fee address should be established when correspondence related to
`maintenance fees should be mailed to a different address than the correspondence address for the application.
`When to check the first box below: If you have a Customer Number to represent the fee address. When
`to check the second box below: if you have no Customer Number representing the desired fee address,
`in which case a completed Request for Customer Number (PTOr‘SBil25) must be attached to this form. For
`more information on Customer Numbers, see the Manual of Patent Examining Procedure (MPEP) § 403.
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`For the following listed applicationts), please recognize as the “Fee Address” under the provisions of 3? CFR
`l.353 the address associated with:
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`
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`E CustomerNumher: 153508
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`OR
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`D The attached Request for Customer Number (PTOISBK125 form.
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`PATENT NUMBER
`(it known}
`
`APPLICATlON NUMBER
`
`8,543,330
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`131621.382
`
`Completed by (check one):
`DApplioant/‘lnventor
`
`EAttorney or Agent of record _ 42540
`(Reg. No.)
`
`EAssignee of record of the entire interest. See 37' CFR 3.71.
`Statement under 3? CFR 3.7300) is enclosed.
`(Form PTOISB/QB)
`[:1 Assignee recorded at Real
`
`Frame
`
`I'TimOthY A. Flory]
`Signature
`TimOthy A- Flory
`Typed or printed name
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`616.649.1924
`
`-
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`Requester’s telephone number
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`June 15, 2018
`Date
`
`NOTE: Signatures of all the inventors or assignees of record of the entire interest or their representativeis} are required. Submit multiple forms if more that one
`si-nature is recurred. see below‘.
`
`forms are submitted.
`* Totat of 1
`This coileotion of infonnation is required by 3? CFR 1.353. 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’ CPR 1. t1 and 1.14. This coils otion is estima ted to take 5 minutes to complete,
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`the amount at time you require to complete this form andior suggestions for reducing this burden, should he sent to the Chief information Officer. LLS. Patent and
`Trademark Office. US. Department of Commerce. P.0. Box, MEG. Alexandria. VA 22313- 1450. DC} NOT SEND COMPLETE D FORMS TO THlS A DDRESS.
`SEND To: Mail Stop M Correspondence, Commissioner for Patents. Pfl. Box 1450, Alexandria, VA 22313—1450.
`if you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.
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