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Recordation Form Cover Sheet Patents Only PTO-1595 - Official Federal Forms
| Recordation Form Cover Sheet Patents Only Form. This is a national form and can be used in Patent US Patent Office . |
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Form PTO-1595 (Rev. 06-12) OMB No. 0651-0027 (exp. 04/30/2015) U.S. DEPARTMENT OF COMMERCE United States Patent and Trademark Office 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 of conveying party(ies) 2. Name and address of receiving party(ies) Name: ____________________________________ Internal Address:____________________________ ___________________________________________________ Additional name(s) of conveying party(ies) attached? Yes No Street Address: _____________________________ 3. Nature of conveyance/Execution Date(s): Execution Date(s)_____________________________ ___________________________________________________ Assignment Security Agreement Merger Change of Name City:______________________________________ State: _____________________________________ Country:___________________Zip:______________ Additional name(s) & address(es) attached? Yes Joint Research Agreement Government Interest Assignment Executive Order 9424, Confirmatory License Other__________________________________ 4. Application or patent number(s): A. Patent Application No.(s) No This document serves as an Oath/Declaration (37 CFR 1.63). B. Patent No.(s) Additional numbers attached? Yes No 5. Name and address to whom correspondence concerning document should be mailed: Name:_____________________________________ Internal Address:_____________________________ ___________________________________________ Street Address:_______________________________ ___________________________________________ City: _______________________________________ State:_____________________Zip:_______________ Phone Number:_______________________________ Docket Number:_____________________________ Email Address:_ ______________________________ 9. Signature: Signature Name of Person Signing 6. Total number of applications and patents involved:____________________________ 7. Total fee (37 CFR 1.21(h) & 3.41) $____________ Authorized to be charged to deposit account Enclosed None required (government interest not affecting title) 8. Payment Information Deposit Account Number __________________ Authorized User Name____________________ Date Total number of pages including cover sheet, attachments, and documents: Documents to be recorded (including cover sheet) should be faxed to (571) 273-0140, or mailed to: Mail Stop Assignment Recordation Services, Director of the USPTO, P.O.Box 1450, Alexandria, V.A. 22313-1450 American LegalNet, Inc. www.FormsWorkFlow.com Guidelines for Completing Patents Cover Sheets (PTO-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 consecutively, for example, if both a patent and trademark cover sheet is used, and information is continued on one additional page for both patents and trademarks, the pages of the cover sheet would be numbered from 1 to 4. Item 1. Name of Conveying Party(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) should 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 agreement, enter the name(s) of the party(ies) other than the owner of the patent or patent application as the conveying party(ies). Item 2. Name and Address of Receiving Party(ies). Enter the name and full address of the first party receiving the interest. If there is more than one party receiving the interest, enter a check 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 the name(s) of the patent or patent application owner(s) as the receiving party. Item 3. Nature of Conveyance/Execution Date(s). Enter the execution date(s) of the document. It is preferable to use the name of the month, or an abbreviation of that name, in order that confusion over dates is minimized. Place a check mark in the appropriate box describing the nature of the conveying document. If the "Other" box is checked, specify the nature of the conveyance. Item 4. Application Number(s) or Patent Number(s). Indicate the application number(s), and/or patent number(s) against which the document is to be recorded. National application 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. Name and Address of Party to whom correspondence concerning the document should be mailed. Enter the name and full address of the party to whom correspondence is to be mailed. Item 6. Total Applications and Patents involved. Enter the total number of applications and patents identified for recordation. Be sure to include all applications and patents identified on the cover sheet and on additional pages. Block 7. Total Fee Enclosed. Enter the total fee enclosed or authorized to be charged. A fee is required for each application and patent against which the document is recorded. Item 8. Payment Information. Enter the deposit account number and authorized user name to authorize charges. Item 9. Signature. Enter the name of the person submitting the document. The submitter must sign and date the cover sheet. Enter the total number of pages including the cover sheet, attachments, and document. This collection of information is required by 35 USC 261 and 262 and 15 USC 1057 and 1060. The information is used by the public to submit (and by the USPTO to process) patent and trademark assignment requests. After the USPTO records the infor
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