PTO/SB/47 (03-09)
`Approved for use through 03/31/2012. OMB 0651-0016
`US. Patent and Trademark Office; US. DEPARTMENT OF COMMERCE
`Underthe Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.
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`“FEE ADDRESS” INDICATION FORM
`
`Fax to:
`
`571-273-6500
`
`Address to:
`
`Mail Stop M Correspondence
`Commissioner for Patents
`P.O. Box 1450
`Alexandria, VA 22313-1450
`
`In addition,
`INSTRUCTIONS: The issue fee must have been paid for application(s) listed on this form.
`only an address represented by a Customer Number can be established as the fee address for
`maintenance fee purposes (hereafter, fee address).
`A fee address should be established when
`correspondence related to maintenance fees should be mailed to a different address than the
`correspondence address for the application. When to check the first box below: If you have a Customer
`Number to represent the fee address. When to check the second box below: If you have no Customer
`Number representing the desired fee address, in which case a completed Request for Customer Number
`(PTO/SB/125) must be attached to this form. For more information on Customer Numbers, see the Manual
`of Patent Examining Procedure (MPEP) ' 403.
`
`For the following listed application(s), please recognize as the “Fee Address” under the provisions of 37 CFR
`1.363 the address associated with:
`
`Customer Number:
`
`29847
`
`OR
`
`CI The attached Request for Customer Number ()PTO/SB/125 form.
`
`PATENT NUMBER
`if known
`
`APPLICATION NUMBER
`
`9,724,686
`
`8/8/2017
`
`Completed by (check one):
`D Applicant/Inventor
`
`n:_.__1....._
`
`/Timothy H. Van Dyke, 43218/
`
`Attorney or Agent of Record 43218
`(Reg. No.)
`
`Timothy H. Van Dyke
`Typed or printed name
`
`I:| Assiqnee of record of the entire interest. See 37 CFR 3.71.
`Statement under 37 CFR 3.73(b) is enclosed.
`(Form PTO/SB/96)
`
`407-926-7726
`Requester’s telephone number
`
`
`
`I:I Assignee recorded at Reel
`
`September 21, 2018
`Date
`NOTE: Signatures of all the inventors or assignees of record of the entire interest or their representative(s) are required. Submit multiple forms if more that
`one
`signature is required, see below*.
`
`Frame
`
`forms are submitted.
`El *Total of
`This collection of information is required by 37 CFR 1.363. The information is required to obtain or retain a benefit by the public which is to file (and by the
`USPTO to process) and application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 5 minutes to
`complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending on the individual case. Any
`comments on the amount of time you require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, US.
`Patent and Trademark Office, US. Department of Commerce, PO. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO
`THIS ADDRESS. SEND TO: Mail Stop M Correspondence, 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.
`
`