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`TRANSMITTAL FOR POWER OF ATTORNEY TO ONE OR MORE
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`PTO/AlA/82A 07-12
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`Approved for use through 11/30/2014. OMB 0651-0035
`U.S. Patent and Trademark Office; US. DEPARTMENT OF COMMERCE
`Under the Papen~ork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.
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`NOTE: This form is to be submitted with the Power of Attorney by Applicant form (PTO/AlA/82B or equivalent) to identify the
`application to which the Power of Attorney is directed, in accordance with 37 CFR 1.5. If the Power of Attorney by Applicant form
`is not accompanied by this transmittal form or an equivalent, the Power of Attorney will not be recognized in the application.
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`
`ANUARY 2015
`
`-:05-791-5513
`
`NOTE: This form must be signed in accordance with 37 CFR 1.33. See 37 CFR 1.4(d) for signature requirements and certifications.
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`If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.
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`A record in this system of records may be disclosed, as a routine use, to a contractor of the
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`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 may be 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)).
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`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
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