PTO/SBi47 (02-09)
`Approved for use through 07/31/2018. OMB 0651-0016
`U.S. Patent and Trademark Office; U.S. GEPARTMENT 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 QMB control number.
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`“FEE ADDRESS”INDICATION FORM
`
`Addressto:
`Mail Stop M Correspondence
`Commissioner for Patents
`P.O. Box 1450
`Alexandria, VA 22313-1450
`
`Fax to:
`574-273-6500
`
`In addition,
`INSTRUCTIONS: 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 correspondencerelated to
`maintenance fees should be mailed to a different address than the correspondence address for the application.
`Whento checkthe 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 (PTO/SB/125) must be attached to this form. For
`more information on Customer Numbers, see the Manual of Patent Examining Procedure (MPEP) § 403.
`
`
`
`For the following listed application(s), please recognize as the “Fee Address” under the provisions of 37 CFR
`1.363 the address associated with:
`
`(i) Customer Number: 153508
`
`OR
`
`J The attached Request for Customer Number (PTO/SB/125) form.
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`PATENT NUMBER
`(if known}
`
`APPLICATION NUMBER
`
`8,543,330
`
`13/6214 ,382
`
`Completed by (check one}:
`LJapplicant/inventor
`
`IM attorney or Agentof record _ 42540
`
`(Reg. No.)
`(im) Assignee of record of the 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_
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`‘Timothy A. Flory/
`Signature
`Timothy A. Flory
`
`Typed or printed name
`616.649.1924
`Requester’s telephone number
`
`June 15, 2018
`Date
`
`NOTE: Signatures ofall the inventors or assignees of record of the entire interest or their representative(s) are required. Submit muttiole forms if more that one
`signature is required see below’.
`
`forms are submitted.
`* Total of 4
`This collection of information is required by 37 CFR 4.363. The information is required to obtain or retain a benefit by the public which is io file (and by the USPTO
`ta process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1. ¢1 and 1.14. This colle ction is estimated to take $ minutes to complete,
`inctuding gathering, preparing, and submitting the completed application forto the USPTO, Time will vary depending upon the individual case. Any comments on
`the amount of time you require fo complete this form and/or suggestions for reducing this burden, shauld be sent to the Chief information Officer, U.S. Patent and
`Trademark Office, U.S. Depar tment of Cammerce, P.O. Box 7450, Alex andria, VA 22313- 1450. DO NOT SEND COMPLETE GO FORMS TO THIS A DDRESS,
`SEND TG: Mail Stop M Correspondence, Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1456.
`if you need assistance in completing the form. call 1-B00-PTO-9199 and select optian 2.
`
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