Form PTO-1595 (Rev. 6-18)
OMB No. 0651-0027 (exp. 10/31/2024)
U.
S. DEPART
MENT OF COMMERCE
United States Patent and Trademark Off
ice
RECORDATION FORM COVER SHEET
PATENTS ONLY
To the Director of the U.S. Patent and Trademark Office: Please record the attached documents or the new address(es) below.
1. Name
o
f c
o
n
v
eyi
n
g
p
ar
t
y
(
ies)
Additional name
(
s) of conveying party(ies) attached? Yes No
2. Name a
n
d a
dd
ress
o
f recei
v
i
n
g
p
ar
t
y
(
ies)
Na
m
e:
Inte
r
nal Add
r
e
ss
:
St
r
eet Add
r
e
ss
:
City:
State:
Country: Zip:
Additional name(s) & address(es) attached?
Yes No
3. Nature of conveyance/Execution Date(s):
Execution Date(s)
Assignment Merger
Security Agreement Change of Name
Joint Research Agreement
Government Interest Assignment
E
x
e
c
utive
Or
der 9424, Confi
rm
ato
r
y
L
i
c
en
s
e
O
the
r
4.
A
ppli
ca
tion or p
a
t
e
nt numb
er
(
s
):
T
his docu
m
ent serves as an Oath/Declaration (37 CFR 1.63).
A. Patent Appli
c
ation No.
(s
) B. Patent No.
(s
)
Additional numbers attached? Yes No
5. Name and address to whom correspondence
6. Total number of applications and patents
concerning document should be mailed:
involved:
Na
m
e:
7. Total fee (37 CFR 1.21(h) & 3.41)
$
Autho
ri
zed to be
c
ha
r
ged to depo
s
it a
c
count
En
c
lo
s
ed
None
required (government interest not affecting title)
Internal Address:
St
r
eet Add
r
e
ss
:
City:
8. Pay
m
e
n
t I
nfo
rma
t
i
o
n
Depo
s
it A
cc
ount Nu
m
ber
Autho
ri
zed U
s
er Na
m
e
State: Zip:
Phone Number:
Docket Number:
Email Address:_
9. Signature:
Signatu
r
e
D
ate
Total number of pages including cover
Name of Person Signing
sheet, attachments, and documents:
D
ocu
me
n
t
s
t
o be
r
eco
r
d
e
d
(
in
c
l
ud
i
n
g
co
ver
s
he
et
) s
h
o
u
ld be f
a
xed to (571) 273-0140, or
m
a
i
l
e
d to:
M
a
i
l
S
top As
s
i
g
n
me
nt
R
e
c
o
r
d
at
i
o
n
S
e
r
vi
c
e
s
,
D
i
r
e
c
tor
o
f the
USP
T
O
,
P
.
O.B
ox
1
45
0
,
A
le
x
a
n
d
r
i
a
,
V.
A.
2
231
3-
1
4
50
G
uidelines for Co
m
pleting
P
atents Cover Sheets
(
P
TO-1595)
Cover Sheet information must be submitted with each document to be recorded. If the document to be
recorded concerns both patents
and trademarks separate patent and trademark cover sheets, including any attached
pages
for continuing information, must accompany the document. All pages of the cover sheet should be numbered
consecuti
v
el
y
,
f
or exa
m
ple, if both a patent and trade
m
ark cover sheet is used, and
i
n
f
or
m
ation is conti
n
ued on one
addit
i
onal pa
g
e
f
or both patents
a
nd tr
a
de
m
ar
k
s, the pa
g
es of the co
v
er sheet
w
ould be nu
m
bered
f
rom 1
to 4.
Item 1. Na
m
e
o
f Co
nv
eyi
n
g P
a
rty(ies).
Enter the full name of the party(ies) conveying the interest. If there is insufficient space, enter a check mark
in
the "Yes" box to indicate that additional information is attached. The name of the additional conveying party(ies)
shou
ld be placed on an attached page clearly identified as a continuation of the information Item 1. Enter a check mark
in
the "No" box, if no information is contained on an attached page. If the document to be recorded is a joint research
a
greement, enter the name(s) of the party(ies) other than the owner of the patent or patent application as the conveying
part
y(ies).
Item 2. Na
m
e and Ad
d
ress of Receivi
n
g P
a
rty(ies).
Enter the na
me and full address of the first party receiving the interest. If there is more than one party
receiving the interest, enter a ch
eck mark in the "Yes" box to indicate that additional information is attached. Enter a
check
mark in the "No" box, if no information is contained on an attached page. If the document to be recorded is a
joint research agreement, enter t
he name(s) of the patent or patent application owner(s) as the receiving party.
Item 3. N
a
t
u
re
o
f Con
v
eya
n
ce/Exec
u
ti
o
n D
a
te(s).
Enter the e
xecution date(s) of the document. It is preferable to use the name of the month, or an abbreviation
of that na
me, in order that confusion over dates is minimized. Place a check mark in the appropriate box describing the
nature of the con
veying document. If the "Other" box is checked, specify the nature of the conveyance.
Ite
m
4
.
A
pp
lic
a
tio
n
Nu
m
ber(s
) or
P
a
te
nt
Nu
m
ber(s)
.
Indicate the
a
pplicat
i
on nu
m
ber(s), and
/
or patent nu
m
ber(s) a
g
ainst
w
hich the
d
ocu
m
ent is to be rec
o
rded.
National a
pplication numbers must include both the series code and a six-digit number (e.g., 07/123,456), and
international application numbers must be complete (e.g., PCT/US91/12345).
Enter a check
mark in the appropriate box: "Yes" or "No " if additional numbers appear on attached pages.
Be sure to
identify numbers included on attached pages as the continuation of Item 4. Also enter a check mark if this
Assignment is being filed as an Oath/Declaration ( 37 CFR 1.63).
Item 5. Na
m
e and Ad
d
ress of P
a
rty to w
h
om c
o
rrespo
n
dence c
o
ncer
n
i
n
g the d
o
cu
m
e
n
t s
h
o
u
ld
b
e
ma
ile
d
.
Enter the na
m
e and
f
ull address
o
f the party to
w
hom correspond
en
ce is to be
m
ailed.
Item 6. T
o
t
a
l Ap
p
lic
a
t
i
o
ns a
n
d P
a
te
n
t
s i
n
v
o
l
v
e
d
.
Enter the total nu
m
ber of applica
t
ions a
n
d patents
i
denti
f
ied
f
or recordat
i
on. Be sure to inc
l
ude all
applicati
o
ns a
n
d pate
n
ts ide
n
ti
f
ied
o
n
t
he co
v
er sheet and on add
i
t
i
onal pa
g
es.
Block 7. Total Fee E
n
close
d
.
Enter the total
f
ee enclosed or au
t
horized to be charged. A
f
ee is required
f
or each applicat
i
on
a
nd patent
a
g
ainst
w
hich the do
c
u
m
ent is recorded.
Item 8. P
a
y
m
e
n
t I
n
f
o
r
ma
ti
on
.
Enter the de
posit account number and authorized user name to authorize charges.
Item 9. Sig
na
t
u
re.
Enter the na
m
e of the person s
ubm
itting the docu
m
ent.
T
he sub
m
itter
m
ust si
g
n and date
t
he co
v
er sheet.
Enter the total nu
mber of pages including the cover sheet, attachments, and document.
Th
i
s col
l
ect
i
on of in
f
or
m
at
i
on
i
s
r
equi
r
ed by 35 USC 261 a
n
d 262 a
n
d 15 USC 1057 a
n
d 1060. T
h
e in
f
or
m
at
i
on
i
s
u
sed by t
h
e publ
ic to
s
u
b
mit (
a
nd
b
y
th
e USP
T
O
t
o p
r
ocess) pa
t
ent and
tr
ade
m
ark ass
i
gn
m
e
n
t
r
eq
u
es
t
s. A
ft
er t
h
e US
PT
O
r
eco
r
ds
th
e
i
n
f
or
m
at
i
o
n
, t
h
e
r
eco
r
ds
f
or pa
t
ent a
n
d
tr
ade
m
a
r
ks,
ass
i
gn
m
e
nt
s, and ot
h
er assoc
i
a
t
ed docu
m
en
t
s can be
in
spec
t
ed by t
h
e p
u
b
li
c.
T
o v
i
ew docu
m
e
n
ts
r
eco
rd
ed u
n
der sec
r
ecy orde
r
s or docu
m
e
nt
s
r
eco
rd
ed
due to
t
he int
e
r
es
t
o
f the f
e
d
e
r
a
l g
o
v
ern
m
e
nt, a writt
e
n
a
u
t
h
or
i
zat
i
o
n mu
s
t be
s
u
b
mi
t
t
ed
. T
h
is
co
ll
ect
i
o
n is
est
im
a
t
e
d to t
a
ke
3
0 mi
n
ut
e
s to
co
m
p
l
e
t
e
,
i
n
cluding
g
at
h
erin
g
, preparing, a
n
d s
u
bmitting t
h
e form to t
h
e USPTO. Any com
m
ents on t
h
e a
m
ou
n
t of ti
m
e
y
ou require to co
m
p
l
e
t
e th
i
s
f
orm a
n
d/or
sug
g
est
i
o
n
s
f
or
r
ed
u
c
i
ng th
i
s bu
r
de
n
, s
h
ould be se
n
t to t
h
e Ma
n
a
g
er of t
h
e
A
ss
i
gn
m
e
n
t Div
i
s
i
o
n
, USPTO, P.O.
B
ox 1450, A
l
e
x
andr
i
a, VA 22313
-
1450.
DO NOT
S
END
F
E
E
S OR COMP
L
ET
E
D
F
ORMS
T
O TH
I
S
A
DDR
E
S
S
.
SE
ND
T
O: Mail
S
top
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ss
i
gn
m
e
n
t Reco
r
dation
S
erv
i
ces, D
ir
ector of t
h
e
USP
T
O, P.O.
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ox 1450, A
l
e
x
andr
i
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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
information is voluntary but is required in order for the USP
T
O to record the requested
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 documents can be inspected by the
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.
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their records management responsibilities under the authority of 44 U.S.C. 2904 and 2906. Such
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