Fill and Sign the Request for Customer Number Data Change Uspto Form

PTO/SB/124A (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 Data Change 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 Firm Name (if applicable) Telephone Number Name of Person submitting request Please delete the following practitioner registration number (s) from the Customer Number indicated above: Please add the following practitioner registration numbers to the Customer Number indicated above: Request Submitted by: Please change Correspondence Address to: Address City State ZIP Telephone Fax Country Address Firm or Individual Name To the Commissioner of Patents and Trademarks: Please record the following data changes to Customer Number: Type Customer Number here 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 Place Customer Number Bar Code Label here Request for Customer Number Data Change Practitioner Registration Number Supplemental Sheet Firm NameDate Additional supplemental sheet(s) attached hereto Page ofPages To the Commissioner of Patents and Trademarks: Please record the following data changes to Customer Number: Please delete the following practitioner registration number fr om the Customer Number indicated above: Please add the following practitioner registration numbers to the Customer Number indicated above: 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 COMPLE TED FORMS TO THIS ADDRESS. SEND TO: Assistant Commissioner for Patents, Box CN, Washington, DC 20231. PTO/SB/124B (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.