PTO/SB/47 (03-09)
`Approvedfor use through 07/31/2018. OMB 0651-0016
`U.S. Patent and Trademark Office; U. S. DEPARTMENT OF COMMERCE
`Under the Paperwork Reduction Act of 1995, no personsare required to respondto a collection of information unless it 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
`
`For the following listed application(s), please recognize as the “Fee Address” underthe provisions of 37 CFR
`1.363 the address associated with:
`
`ml Customer Number:
`
`1 53508
`
`OR
`
`LJ The attached Request for Customer Number (PTO/SB/125) form.
`
`PATENT NUMBER
`(if known)
`
`APPLICATION NUMBER
`
`8,147,077
`
`13/071,174
`
`Completed by (check one):
`LJappticant/inventor
`
`IMattorney or Agentof record _ 42940
`
`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 attached to this form. For
`more information on Customer Numbers, see the Manualof Patent Examining Procedure (MPEP)§ 403.
`
`
`
`(Reg. No.)
`[_]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)
`
`LJassignee recorded at Reel
`
`Frame_
`
`‘Timothy A. Flory/
`Signature
`
`Timothy A. Flory
`
`Typed or printed name
`61 6.649.1924
`Requester’s telephone number
`
`May 1 1 , 201 8
`
`Date
`
`NOTE:Signaturesof all the inventors or assigneesof record ofthe entire interest or their representative(s) are required. Submit multiple formsif more that one
`signature is required, see below’.
`
`forms are submitted.
`* Total of 4
`This collection of information is required by 37 CFR 1.363. 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 5 minutes to complete,
`including gathering, preparing, and submitting the completed application form to the USPTO. Timewill vary depending uponthe individual case. Any comments on
`the amountof time you require to complete this form and/or suggestions for reducing this burden, should be sentto the Chief Information Officer, U.S. Patent and
`Trademark Office, U.S. Depar tment 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 select option 2.
`
`