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`PART B—ISSUE FEE TRANS
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`Complete and mail this form, togetherwith app:.cable fees,to:
`
`Box ISSUE FEE
`Assistant Commissionerfor Patents,
`Washington, D.C. 20231
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`Note: Thecertificate of mattmg-befow can only be used for domestic
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`MAILING INSTRUCTIONS:This form should be used for transmitting the ISSUE FEE. Blocks 1
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`1. Change of correspondence addressorindication of “ Fee Address” (37 CFR 1.363).
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`(Change of correspondence address (or Change of Correspondence Address form
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`3. ASSIGNEE NAME AND RESIDENCE DATA TO BE PRINTED ON THE PATENT(print or type)
`PLEASE NOTE:Unlessan assigneeis identified below, no assignee data will appear on the patent.
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`(B) RESIDENCE:(CITY & STATE OR COUNTRY) Fairfield, New Jersey
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`4a. The following fees are enclosed (make check payable to Commissioner
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`Please checkthe appropriale assignee category indicated below (will not be printed on the patent)
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`Pay
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`NOTE;The Issue Feewill not be accepted from anyoneother than the applicant; a registered attomey
`or agent; or the assignee or other party in interest as shown bythe records of the Patent and
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`Burden Hour Statement:This form is estimated to take 0.2 hours to complete. Timewill vary
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`Underthe Paperwork Reduction Act of 1995, no persons are required to respondto a collection
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`TRANSMIT THIS FORM WITH FEE
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`Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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