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 respond to a collection of information unlessit displays a valid OMB control number.
`
`“FEE ADDRESS”INDICATION FORM
`
`Addressto:
`Mail Stop M Correspondence
`Commissioner for 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” under the provisions of 37 CFR
`1.363 the address associated with:
`
`Customer Number: 35 1 6 1
`
`OR
`
`[] The attached Request for Customer Number (PTO/SB/125) form.
`
`PATENT NUMBER
`(if known)
`
`APPLICATION NUMBER
`
`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 addressfor the application.
`When to check thefirst 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.
`
`forms are submitted.
`
`Completed by (check one):
`L| Applicant/Inventor /Stacey J. Longanecker/
`
`Signature
`
`Attorney or Agent of record _33,952
`(Reg. No.)
`
`Stacey J. Longanecker
`Typed or printed name
`
`C] Assigneeof record of the entire interest. See 37 CFR 3.71.
`Statement under 37 CFR 3.73(b) is enclosed.
`(Form PTO/SB/96)
`LJ Assignee recorded at Reel
`
`Frame
`
`(202) 457-0160
`Requester’s telephone number
`
`March 17, 2021
`
`Date
`
`NOTE: Signaturesof all the inventors or assignees of record of the entire interest or their representative(s) are required. Submit multiple forms if more that one
`signature is required, see below*.
`
`* Total of
`C]
`This collection of information is required by 37 CFR 1.363. The information is required to obtain or retain a benefit by the public whichis 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 colle ction 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 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 FORMS TO 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.
`
`

`

`Privacy Act Statement
`
`The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection
`with your submission of the attached form related to a patent application or patent. Accordingly,
`pursuant to the requirements of the Act, please be advised that: (1) the general authority for the
`collection of this information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary;
`and (3) the principal purpose for which the information is used by the U.S. Patent and Trademark
`Office is to process and/or examine your Submission related to a patent application or patent. If you do
`not furnish the requested information, the U.S. Patent and Trademark Office may not be able to
`process and/or examine your submission, which may result in termination of proceedings or
`abandonmentof the application or expiration of the patent.
`
`The information provided by you in this form will be subject to the following routine uses:
`
`1. The information on this form will be treated confidentially to the extent allowed under the
`Freedom ofInformation Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from
`this system of records maybe disclosed to the Department of Justice to determine whether
`disclosure of these records is required by the Freedom ofInformation Act.
`A record from this system of records may be disclosed, as a routine use, in the course of
`presenting evidenceto a court, magistrate, or administrative tribunal, including disclosures to
`opposing counsel in the course of settlement negotiations.
`A record in this system of records may be disclosed, as a routine use, to a Member of
`Congress submitting a request involving an individual, to whom the record pertains, when the
`individual has requested assistance from the Member with respect to the subject matter of the
`record.
`A record in this system of records may be disclosed, as a routine use, to a contractor of the
`Agency having needfor the information in order to perform a contract. Recipients of
`information shall be required to comply with the requirements of the Privacy Act of 1974, as
`amended, pursuant to 5 U.S.C. 552a(m).
`A record related to an International Application filed under the Patent Cooperation Treaty in
`this system of records maybe disclosed, as a routine use, to the International Bureau of the
`World Intellectual Property Organization, pursuant to the Patent Cooperation Treaty.
`A record in this system of records may be disclosed, as a routine use, to another federal
`agency for purposes of National Security review (35 U.S.C. 181) and for review pursuant to
`the Atomic Energy Act (42 U.S.C. 218(c)).
`A record from this system of records may be disclosed, as a routine use, to the Administrator,
`General Services, or his/her designee, during an inspection of records conducted by GSA as
`part of that agency’s responsibility to recommend improvements in records management
`practices and programs, under authority of 44 U.S.C. 2904 and 2906. Such disclosure shall
`be made in accordance with the GSA regulations governing inspection of records for this
`purpose, and any other relevant (/.e., GSA or Commerce) directive. Such disclosure shall not
`be used to make determinations aboutindividuals.
`A record from this system of records may be disclosed, as a routine use, to the public after
`either publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent
`pursuant to 35 U.S.C. 151. Further, a record may be disclosed, subject to the limitations of 37
`CFR 1.14, aS a routine use, to the public if the record wasfiled in an application which
`became abandonedor in which the proceedings were terminated and which application is
`referenced byeither a published application, an application open to public inspection or an
`issued patent.
`A record from this system of records may be disclosed, as a routine use, to a Federal, State,
`or local law enforcement agency, if the USPTO becomes awareof a violation or potential
`violation of law or regulation.
`
`