Form PTO-1595 "Recordation Form Cover Sheet"

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U.S. DEPART
M
E
N
T OF COMMERCE
Form PTO-1595
Rev
-18
(
. 6
)
O
B No. 0651-0027 (exp. 06/30/2021)
United States Patent and Trademark Off
i
ce
M
RECORD A TION FO RM C O VER SHEET
P AT EN T S O NLY
To the Director of the U.S. Patent and Trademark Off
i
ce: Please record the attached documents or t
h
e new address(es) belo
w
.
o f c o n v eyi n g p ar t y ( ies)
n d a dd ress o f recei v i n g p ar t y ( ies)
1. Name
2. Name a
m e:
Na
Inte
r nal Add r e ss :
Additional name
s) of conveying party(ies) attached?
Yes
No
(
tu re o f c onv eya n ce/Exec ut i o n Da t e ( s ) :
St
r eet Add r e ss :
3. Na
x e c ution Date (s)
E
ss ign m en t
r ger
A
Me
t y:
Ci
c u r i t y Ag r ee m ent
m e
Se
Change of Na
J oint Re s ea rc h Ag r ee m ent
State:
Go v ernment Inter e st Ass ig nment
Count
r y:
Z ip:
x e c utive Or der 9424, Confi rm ato r y L i c en s e
E
O the r
e
N
Addi
io
al
a
e(s) & add
e
s
es)
tt
ch
d?
Y
s
o
t
n
n
m
r
s
(
a
a
e
ppli ca tion or p a t e nt numb er ( s ):
4. A
T his docu m ent serves as an Oath/Declaration (37 CFR 1.63).
c ation No. (s )
(s )
A. Patent Appli
B. Patent No.
Additional numbers attached?
Yes
No
5. Name and address to whom correspondence
. Tot a l num be r of a ppli ca tions a nd p a t e nts
6
on cer ning do c um e nt s hould be m a il e d:
c
nvo lve d:
i
m e:
Na
$
7. Total fe e ( 37 C F R 1.21(h) & 3.41)
Inte
r nal Add r e ss :
ri zed to be c ha r ged to depo s it a c count
Autho
En
c lo s ed
r eet Add r e ss :
St
None
r equi r ed
(go
ern
ent
nter
st
ot
ff
cti
g t
tle)
v
m
i
e
n
a
e
n
i
m e n t I nfo rma t i o n
8. Pay
t y:
Ci
State:
Z ip:
Phone Nu
m be r :
s it A cc ount Nu m ber
Depo
Docket Number:
Autho
ri zed U s er Na m e
m ail Add r e ss: _
E
. Si gn a tu re :
9
r e
D ate
Signatu
Total number of pages including cover
sheet, attachments, and documents:
Na
m e of Pe rs on Signing
D
me
t
t
r
r
e
(
c
ud
n
co
s
et
h
u
a
m
i
e
ocu
n
s
o be
eco
d
d
in
l
i
g
ver
he
) s
o
ld be f
xed to (571) 273-0140, or
a
l
d to:
M
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s
g
me
R
c
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at
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c
s
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1
50
U.S. DEPART
M
E
N
T OF COMMERCE
Form PTO-1595
Rev
-18
(
. 6
)
O
B No. 0651-0027 (exp. 06/30/2021)
United States Patent and Trademark Off
i
ce
M
RECORD A TION FO RM C O VER SHEET
P AT EN T S O NLY
To the Director of the U.S. Patent and Trademark Off
i
ce: Please record the attached documents or t
h
e new address(es) belo
w
.
o f c o n v eyi n g p ar t y ( ies)
n d a dd ress o f recei v i n g p ar t y ( ies)
1. Name
2. Name a
m e:
Na
Inte
r nal Add r e ss :
Additional name
s) of conveying party(ies) attached?
Yes
No
(
tu re o f c onv eya n ce/Exec ut i o n Da t e ( s ) :
St
r eet Add r e ss :
3. Na
x e c ution Date (s)
E
ss ign m en t
r ger
A
Me
t y:
Ci
c u r i t y Ag r ee m ent
m e
Se
Change of Na
J oint Re s ea rc h Ag r ee m ent
State:
Go v ernment Inter e st Ass ig nment
Count
r y:
Z ip:
x e c utive Or der 9424, Confi rm ato r y L i c en s e
E
O the r
e
N
Addi
io
al
a
e(s) & add
e
s
es)
tt
ch
d?
Y
s
o
t
n
n
m
r
s
(
a
a
e
ppli ca tion or p a t e nt numb er ( s ):
4. A
T his docu m ent serves as an Oath/Declaration (37 CFR 1.63).
c ation No. (s )
(s )
A. Patent Appli
B. Patent No.
Additional numbers attached?
Yes
No
5. Name and address to whom correspondence
. Tot a l num be r of a ppli ca tions a nd p a t e nts
6
on cer ning do c um e nt s hould be m a il e d:
c
nvo lve d:
i
m e:
Na
$
7. Total fe e ( 37 C F R 1.21(h) & 3.41)
Inte
r nal Add r e ss :
ri zed to be c ha r ged to depo s it a c count
Autho
En
c lo s ed
r eet Add r e ss :
St
None
r equi r ed
(go
ern
ent
nter
st
ot
ff
cti
g t
tle)
v
m
i
e
n
a
e
n
i
m e n t I nfo rma t i o n
8. Pay
t y:
Ci
State:
Z ip:
Phone Nu
m be r :
s it A cc ount Nu m ber
Depo
Docket Number:
Autho
ri zed U s er Na m e
m ail Add r e ss: _
E
. Si gn a tu re :
9
r e
D ate
Signatu
Total number of pages including cover
sheet, attachments, and documents:
Na
m e of Pe rs on Signing
D
me
t
t
r
r
e
(
c
ud
n
co
s
et
h
u
a
m
i
e
ocu
n
s
o be
eco
d
d
in
l
i
g
ver
he
) s
o
ld be f
xed to (571) 273-0140, or
a
l
d to:
M
i
S
s
g
me
R
c
r
at
o
S
r
c
s
D
r
c
o
USP
O
P
O.B
1
0
A
x
n
r
a
V.
2
3-
4
a
l
top As
i
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nt
e
o
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e
vi
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,
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tor
f the
T
,
.
ox
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,
le
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d
i
,
A.
231
1
50
G uidelines for Co m pleting P atents Cover Sheets
( P TO-1595)
Co
er Sheet in
or
ation
ust be sub
itted
ith each docu
ent to be recorded. If the
ocu
ent to
e
v
f
m
m
m
w
m
d
m
b
recorded concerns both patents
d trade
arks separate patent and
rademark cover sheets, inclu
ing any attached
an
m
t
d
pages
or cont
nu
ng in
or
ation,
ust acco
pany the docu
ent.
ll pages of the cover sheet sho
d be nu
bered
f
i
i
f
m
m
m
m
A
ul
m
consecuti
el
,
or exa
ple, if both a patent and trade
ark cover sheet is used, and
n
or
ation is conti
ued on one
v
y
f
m
m
i
f
m
n
addit
onal pa
e
or both patents
nd tr
de
ar
s, the pa
es of the co
er sheet
ould be nu
bered
rom 1
i
g
f
a
a
m
k
g
v
w
m
f
to 4.
Item 1. Na
e
f Co
eyi
g P
rty(ies).
m
o
nv
n
a
Enter the
ull na
e of the part
(ies) con
e
ing the interest. If there is insu
icient space, enter a check
ark
f
m
y
v
y
ff
m
in
he "Yes" box to
ndicate that
ddit
onal in
or
ation is attached.
he name of the addit
onal con
e
ing part
(ies)
t
i
a
i
f
m
T
i
v
y
y
shou
d be placed on
n attached page clearly identi
ied as a continuation of the in
or
ation Item 1.
nter a check mark
l
a
f
f
m
E
in
he "No" box, if no
n
or
ation is contained on an attached page. If the do
u
ent to be reco
ded is a jo
nt research
t
i
f
m
c
m
r
i
a
reement, enter the na
e(s) of the part
(ies) other than the o
ner of the patent or patent
pplicat
n as the c
n
e
ing
g
m
y
w
a
io
o
v
y
part
(ies).
y
Item 2. Na
e and Ad
ress of Receivi
g P
rty(ies).
m
d
n
a
Enter the na
e and
ull address of the
irst party receiving the inte
est. If there is
ore than one par
y
m
f
f
r
m
t
receiving the interest, enter a ch
ck
ark in the "Yes" box
o i
di
ate that add
ti
nal
n
ormation is attached. Enter a
e
m
t
n
c
i
o
i
f
check
ark in the "No" bo
, if no in
or
ation is conta
ned on an a
tached page. If the docu
ent to be recorded is a
m
x
f
m
i
t
m
joint research agreement, enter t
e na
e(s) of the patent or patent applicat
on o
ner(s) as the receiving part
.
h
m
i
w
y
Item 3. N
t
re
f Con
eya
ce/Exec
ti
n D
te(s).
a
u
o
v
n
u
o
a
Enter the e
ecuti
n date(s) of the docu
ent. It is pre
erable to use
he na
e of the
onth, or an abb
e
iation
x
o
m
f
t
m
m
r
v
of that na
e, in o
der that con
usion o
er dates is
ini
ized. Place a check
ark in the appropriate box describ
ng the
m
r
f
v
m
m
m
i
nature of the con
v
e
y
ing docu
m
ent. If the "Other" box is
c
hecked, specify the nature of the con
v
e
y
ance.
Ite
4
A
lic
tio
Nu
ber(s
P
te
Nu
ber(s)
m
.
pp
a
n
m
) or
a
nt
m
.
Indicate the
pplicat
on nu
ber(s), and
or patent nu
ber(s) a
ainst
hich the
ocu
ent is to be rec
rded.
a
i
m
/
m
g
w
d
m
o
National a
plicati
n
u
bers
ust incl
de
oth the series code
d a si
-di
it
u
ber (e.
., 07
1
3
45
), a
d
p
o
n
m
m
u
b
an
x
g
n
m
g
/
2
,
6
n
internat
onal a
plicati
n nu
bers
ust be co
plete (e.
., PC
/US91
1
3
5).
i
p
o
m
m
m
g
T
/
2
4
Enter a check
ark in the approp
iate bo
: "Yes" or "No " if addi
onal nu
bers appear on attached pages.
m
r
x
ti
m
Be sure to
denti
y nu
bers included on attached pages as the cont
nuat
on of Item 4.
lso enter a check
ark if this
i
f
m
i
i
A
m
A
ssi
g
n
m
ent is being
f
iled as an Oath/Declaration (
37 CFR 1.63).
Item 5. Na
e and Ad
ress of P
rty to w
om c
rrespo
dence c
ncer
i
g the d
cu
e
t s
o
ld
e
m
d
a
h
o
n
o
n
n
o
m
n
h
u
b
ile
. Enter the na
ma
d
e and
ull address
f the party to
hom correspond
ce is to be
ailed.
m
f
o
w
en
m
Item 6. T
t
l Ap
lic
i
ns a
d P
te
s i
v
l
e
.
o
a
p
a
o
n
a
n
n
o
v
d
t
t
Enter the total nu
ber of applica
ions a
d patents
denti
ied
or recordat
on. Be sure to inc
ude all
m
t
n
i
f
f
i
l
applicati
ns a
d pate
ts ide
ti
ied
n
he co
er sheet and on add
t
onal pa
es.
o
n
n
n
f
o
t
v
i
i
g
Block 7. Total Fee E
close
.
n
d
Enter the total
ee enclosed or au
horized to be charged. A
ee is required
or each applicat
on
nd patent
f
t
f
f
i
a
a
ainst
hich the do
u
ent is recorded.
g
w
c
m
Item 8. P
y
e
t I
f
r
ti
.
a
m
n
n
o
ma
on
Enter the de
p
osit acco
u
nt nu
m
ber and autho
r
ized user na
m
e to au
t
horize charges.
Item 9. Sig
t
re.
na
u
Enter the na
e of the person s
itting the docu
ent.
he sub
itter
ust si
n and date
he co
er sheet.
m
ubm
m
T
m
m
g
t
v
Enter the total nu
ber of pa
es includ
ng the co
er sheet, attach
ents, a
d
ocu
ent.
m
g
i
v
m
n
d
m
Th
s col
ect
on of in
or
at
on
s
equi
ed by 35 USC 261 a
d 262 a
d 15 USC 1057 a
d 1060. T
e in
or
at
on
s
sed by t
e publ
s
b
a
b
i
l
i
f
m
i
i
r
r
n
n
n
h
f
m
i
i
u
h
ic to
u
mit (
nd
y
e USP
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o p
ocess) pa
ent and
ade
ark ass
gn
e
t
eq
es
s. A
er t
e US
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eco
ds
e
n
or
at
o
, t
e
eco
ds
or pa
ent a
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ade
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ks,
th
T
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s, and ot
er assoc
a
ed docu
en
s can be
spec
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e p
b
c.
o v
ew docu
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eco
ed u
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s or docu
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n mu
t be
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. T
is
ll
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n is
im
t
d to t
ke
0 mi
ut
s to
m
l
t
,
i
cluding
at
erin
, preparing, a
d s
bmitting t
e form to t
e USPTO. Any com
ents on t
e a
ou
t of ti
e
ou require to co
p
e
e th
s
orm a
d/or
n
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t to t
e Ma
a
er of t
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ss
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t Div
s
o
, USPTO, P.O.
ox 1450, A
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andr
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1450.
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DO NOT
END
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ET
D
ORMS
O TH
S
DDR
S
.
ND
O: Mail
top
ss
gn
e
t Reco
dation
erv
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ector of t
e
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USP
O, P.O.
ox 1450, A
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andr
a, VA 22313
1450.
T
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Privacy Act Statement for Patent Assignment Recordation Form Cover Sheet
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in
connection with the above request for information. This collection of information is authoriz ed
by 35 U.S.C. 1, 2, 261 and E.O. 9424. This information will primarily be used by the USPTO
for the recordation of assignments related to patents and patent applications. Submission of this
O to record the requested
information is voluntary but is required in order for the USP
T
assignment. If you do not provide the information required on the cover sheet, the assignment
will not be recorded, and all documents will be returned to you.
After the information is recorded, the records and associated docume
ts can be inspected by the
n
public and are not confidential, except for documents that are sealed under secrecy orders or
related to unpublished patent applications. Assignment records relating to unpublished patent
applications are maintained in confidence in accordance with 35 U.S.C. 122.
Records open to
the public are searched by users for the purpose of determining ownership for other property
rights with respect to patents and trademarks.
Routine uses of the information you provide may also include disclosure to appropriate Federal,
state, local, or foreign agencies in support of their enforcement duties and statutory or regulatory
missions, including investigating potential violations of law or contract and awarding contracts
or other benefits; to a court, magistrate, or administrative tribunal in the course of presenting
evidence; to members of Congress responding to requests for assistance from their constituents;
to the Office of Management and Budget in connection with the review of private relief
legislation; to the Department of Justice in connection with a Freedom of Information Act
request; to a contractor in the performance of their duties; to the Office of Personnel
Management for personnel studies; and to the General Services Administration (GSA) as part of
their records management responsibilities under the authority of 44 U.S.C. 2904 and 2906. Such
disclosure to GSA shall not be used to make determinations about individuals.
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