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Request For The Recording Of A Change PCT-RO-113 - Official Federal Forms

Request For The Recording Of A Change Form. This is a national form and can be used in Receiving Office PCT US Patent Office .
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PATENT COOPERATION TREATY From the RECEIVING OFFICE To: PCT REQUEST FOR THE RECORDING The International Bureau of WIPO OF A CHANGE 34, chemin des Colombettes 1211, Geneva 20 (PCT Rule 92bis.1) Switzerland Date of mailing (day/month/year) International application No. International filing date (day/month/year) 1. The following indications appear on record concerning: the applicant the inventor the agent the common representative Name and address State of Nationality*State of Residence* Telephone No. Facsimile No. Teleprinter No. 2. This receiving Office hereby requests the International Bureau to record the following change in: the person the name the address the nationality* the residence* State of Nationality*State of Residence* Name and address Telephone No. Facsimile No. Teleprinter No. 3. Further observations, if necessary: * To be indicated only for a change concerning the applicant. Name and mailing address of the receiving Office Authorized officer Facsimile No. Telephone No. Form PCT/RO/113(July 1992; reprint January 2004)
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