Fill and Sign the Ptosb125a 8 96 Form

PTO/SB/125A (8-96) Approved for use through 6/30/99. OMB 0651-0035 Patent and Trademark Office: U.S. DEPARTMENT OF COM MERCE Under the Paperwork Reduction Act of 1995, no perso ns are required to respond to a collection of information unless it displays a valid OMB control numbe r. Request for Customer Number Address to: Assistant Commissioner for Patents Box CN Washington, DC 20231 Additional practitioner registration numbers are li sted on supplemental sheet(s) attached hereto Signature Date Request Submitted by: To the Commissioner of Patents and Trademarks: Please assign a Customer Number to the Corresponden ce Address indicated below. Please associate the following practitioner regist ration number(s)with the Customer Number assigned t o the Correspondence Address cited above. Firm Name (if applicable) Telephone Number Name of Person submitting request Address City State ZIP Telephone Fax Country Address Firm or Individual Name Burden Hour Statement: This form is estimated to ta ke 0.2 hours to complete. Time will vary depending upon the needs of the individual case. Any comments on the amount of time you are required to complete this form should be sent to the Chief Information Officer, Patent and Trademark Office, Washington, DC 20231. DO NOT SEND FEES OR COMPLE TED FORMS TO THIS ADDRESS. SEND TO: Assistant Commissioner for Patents, Box CN, Washington, DC 20231. Please type a plus sign (+) inside this box Request for Customer Number Please associate the following Practitioner Registration Numbers with the Customer Number assigned to the Correspondence Address cited on Request for Customer Number form attached. Practitioner Registration Number Supplemental Sheet Firm NameDate Additional supplemental sheet(s) attached hereto Page ofPages Burden Hour Statement: This form is estimated to take 0.2 hours to complete. Time will vary depending upon the needs of the individual case. Any comments on the amount of time you are required to complete this form should be sent to the Chief Information Officer, Patent and Trademark Office, Washington, DC 20231.DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Assistant Commissioner for Patents, Box CN, Washington, DC 20231. PTO/SB/125B (8-96) Approved for use through 6/30/99. OMB 0651-0035 Patent and Trademark Office: U.S. DEPARTMENT OF COM MERCE Under the Paperwork Reduction Act of 1995, no perso ns are required to respond to a collection of information unless it displays a valid OMB control numbe r.