Doc Code: MFEE.C.AD
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`Document Description: Maintena rice Fee Address Change
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`PTO/AiA/47 (11» ‘18)
`Approved for use throtgh 09/30/202 1‘ GM B 065 H916
`L33 Patent and Trademark Office; U.S. DEPARTM ENT OF COME» r(CE
`Under the Paperwork Reduction Actof1995, no person is required to respond to a coilection of infornation unless it displays a valid OMBcontroi numbers
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`address to:
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`Fax to:
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`"FEE ADBRESS" ENDECATEQN FQRM
`
`Mai! Stop M Correspondence
`Commissioner for Patents
`9.0. Box 145E}
`Aiexandria, VA 22313-1456)
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`571-273—6590
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`iNSTRUCTiQNS: The issue fee must have been paid for the applicationis) iisted on this form. in addition, oniy an address
`represented by a Customer Number can be estabiished asthe fee address for maintenance fee purposes (hereafter, fee
`address). Afee address shouid be established when correspondence related to maintenancefees should be mailed to a
`different address than the correspondenceaddress iort‘he appiication.
`Whento checkthefirs‘t box heiow: it"you have a Customer Nuintz-erto represent the fee address.
`
`ifyou have no Customer Number representingthe desired fee address, in which
`When to checkthe second box beiow:
`case a completed Reduestfor Customer Number (PTO,I’SB/1ZS) must be attached to this form. For more information. on
`Customer Numbers, see the Manual ofPaterit Examining Procedure (MPE. )§ 403.
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`address associated with:
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`Customeri‘durriber: 22847
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`0R
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`FATE NT N U M B ER
`1. ;.
`iii Known)
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`APPLiCATiON NUMBER
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`Completed by {check one):
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`Ap p i i c a nt/i nve ntor
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`
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`[Toni—June“ Herbert!
`_———“———-;,————“—*————————“—
`or g n a t u re
`
`
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`Attorney “Agent of ,emrd 50—2036
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`Toni—Jurieii Herbert
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`Assignee of record ofthe entire interest.5ee
`37 CFR 3.71. Statement under 3.7 CFR 3.73M
`(Form PiO/AiA/S‘E) is enclosed or was flied on
`
`Date
`ifthe assi ,nee is a
`NOTE: Signatures ot'aii the inventors or assignees of record of the entire interest or their representativeCs) are required.
`juristic entity, this form must be signed by a patent practitioner (attorney or agent) or” record Submit multiple forms more than one
`signature is required, see beiow*.
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`forms are submitted
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`This L0 action of information is required by 3/(.l-ri l..x63 The information is i quired to obtain or retain a benefit by the pubiit‘, which is to indicate (and for the
`USPTO to process) a fee address. Confidentiaiity is governed by 35 U.S.C,122 and 37 cm 1.11 and 1.14.1'his coiiection is estimated to take 5 minutes to compiete
`including gathering, preparing, and submitting the completed form to the USPTO. Time wiii vary depending upon the individual case. Any comments on the amount
`of time you reduire to cornoiete this form and/or suggestions for reducing this burden, should be sent to the Chief information Officer, U.S. Patent and Trademark
`Office, US. Department of Commerce, PO. Box 1450, Aiexaridria, VA 2.2.3 8-1450. DO NOT SEND COi‘, PLETED FORMSTO TH E PREVEOLJS ADDRESS. SEND COMPIEFED
`FORMS TO: Mai! Stop i‘v’i Correspondence, Commissioner for Patents, PLO. Box 1450, Alexandria, VA 2231312150;
`if you need assistance in completing theform, ca/l l--300—F/"O-91 99 and select option 2.
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`

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`Privacy Act Statern eat
`
`The Privacy Act of 191% (PL. 93—579) requires thatyou be given certain information in connection with your
`submission of the attached form rotated to a patent apoiication or patent. Accordingly, pursuant to the
`requirements otthe Act, piease he advised that: (1)the generai authoritytorthe coiiection ofthis information is
`35 USS. 2(b)(2); (2) furnishing otthe information soiicited is voiuntary;and (3) the principai purpose torwhich
`the information is used bythe US. Patent and Trademark Office is to process and/orexamine yoursuomission
`reiated to a oatehtappiication or patent. it you do not furnish the requested information, the US. Patent and
`Trademark Office maynot he ahieto process and/orexamine yoursuhmission,which mayresuitin termination
`of proceedings or ahandonmentotthe apptication orexpiration ot'the patent.
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`The information provided hyyou in this form wiii he suhiectto the toiiowing routine uses:
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`1 .
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`N!
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`The information on this form wiii he treated confidentiatiyto the extent aiiowed underthe Freedom of
`information Act (5 USC. 552) and the Privacy Act (5 U.S.C 552a). Records from this system otrecords
`may be disciosed to the Departmentoftiustice to determine whetherdisciosure of these records is
`required hythe Freedom otintormation Act.
`A record from this system of records may he disciosed, as a routine use, in the course otpresenting
`evidence to a court, magistrate, or administrative tribu nai, inciuding disciosures to opposing counsei in
`the course ofsettiementnegotiations.
`A record in this system of records may he disciosed, as a routine use, to a Member of Congress
`submitting a reguestinvoiving an individuai,to whom the record pertains,wnen the individuai has
`requested assistance from the Mean herwith res pectto the subjectmatterotthe record.
`A record in this system of records may he disciosed, as a routine use, to a contractor of the Agency
`having need forthe information in orderto perform a contract. Recipients otintormation shaii he required
`to compiywith the requirements otthe Privacy Act of 1 974, as amended, pursuantto 5 U.S.C. 552a(m).
`A record reiated to an internationai Appiication flied underthe PatentCooperation Treatyin this system
`of records may he disciosed, as a routine use, to the internationai Bureau of the Worid inteiiectuai
`Property Organization, pursuantto the PatentCooperation Treaty.
`A record in this system of records may he disciosed, as a routine use. to anotherfederai agencytor
`purposes ofNationai Security review (35 USC. 181) and for review pursuantto the Atomic Energy Act
`(42 USC. 2t8(c}).
`A record from this system of records mayhe disciosed,as a routine use,to the Administrator, Generai
`Services , or hislherdesignee, during an inspection of records conducted hyGSA as part o‘ithatagencys
`responsihiitty to recommend improvements in records managementpractices and programs, under
`authority of 44 UNSC 2904 and 2906. Such discios ure shaii he made in accordance with the GSA
`reguiations governing inspection of records for this purpose, and any other reievant (i.e., GSA or
`Commerce) directive. Such disciosure shaii not he used to mate determinations about individuais.
`A record from this system of records may he disciosed, as a routine use, to the puoiic after either
`puhiication otthe appiication oursuantto 35 U.S.C.122(b)orissuance ofa patentpursuantto 35 USC.
`151. Further, a record may he disciosed,subjectto the iirnitations ot37 CFR 1.14, as a routine use,to
`the puhiic itthe record was tried in an appiication which became abandoned orin which the proceedings
`were terminated and which appiication is referenced oyeithera ouhtished appiication, an appiication
`open to puhiicinspection oran issued patent.
`A record from this system otrecords may he disciosed, as a routine use,to a Federai, State, or iocai iaw
`enforcement agency, if the USPTC) becomes aware of a vioiation or potentiai vioiation ot' iaw or
`regutation.
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