Change of Correspondence Address Patent

Legal Form NumberAIA/123
CourtUnited States Patent and Trademark Office
SectionUnited States Patent and Trademark Office
Doc Code:
PTO/AIA/123 (08-12)
Approved for use through 09/30/2025. OMB 0651-0035
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.
CHANGE OF
CORRESPONDENCE ADDRESS
Patent
Address to:
Mail Stop Post Issue
Commissioner for Patents
P.O. Box 1450
Alexandria, VA 22313-1450
Patent Number
Issue Date
Application Number
Filing Date
First Named Inventor
Attorney Docket
Number
Please change the Correspondence Address for the above-identified patent to:
The address associated with Customer Number:
OR
Firm or
Individual Name
Address
City State ZIP
Country
Telephone Email
This form cannot be used to change the data associated with a Customer Number. To change the data associated with an
existing Customer Number use "Request for Customer Number Data Change" (PTO/SB/124).
This form will not affect any "fee address" provided for the above-identified patent. To change a "fee address" use the "Fee
Address Indication Form" (PTO/SB/47).
I am the:
Patentee.
If the Patentee was not the applicant for patent (37 CFR 1.42), then a Statement under 37 CFR 3.73(c)
(Form PTO/AIA/96 or equivalent) is enclosed or was filed on __________________. See 37 CFR 3.71.
Attorney or agent of record. Registration Number _____________________.
Patent practitioner acting in a representative capacity whose correspondence address is the correspondence
address of record. Notice has been given to the patentee or owner. Registration Number ____________________.
Signature
Typed or
Printed Name
Date Telephone
NOTE: This form must be signed in accordance with 37 CFR 1.33. See 37 CFR 1.4(d) for signature requirements and certifications.
Submit multiple forms if more than one signature is required, see below*.
*Total of ____________ forms are submitted.
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an
information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a currently valid OMB Control
Number. The OMB Control Number for this information collection is 0651-00**. Public burden for this form is estimated to average ** hour per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information
collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the
Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email InformationCollection@uspto.gov.
DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. If filing this completed form by mail, send to: Commissioner for Patents, P.O. Box
1450, Alexandria, VA 22313-1450.
If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

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