PTO/SB/84 (11-08) Approved for use through 0/31/201. 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 contains a valid OMB control number. In re Application of: Application No. Filed: Title: Attorney Docket No. Art Unit: The practitioner named below is authorized to conduct interviews and has the authority to bind the principal concerned. (Note: pursuant to 37 CFR 10.57(c), a practitioner cannot authorize other registered practitioners to conduct interviews without consent of the client after full disclosure.) Furthermore, the practitioner is authorized to file correspondence in the above - identifi ed application pursuant to 37 CFR 1.34: Name Registration Number This is not a Power of Attorney to the above - named practitioner . Accordingly, the practitioner named above does not have authority to sign a request to change the correspondence address, a request for an express abandonment, a disclaimer, a power of attorney, or other document requiring the signature of the applicant, assignee of the entire interest or an attorney of record. If appropriate, a separate Power of Attorney to the above - named practitioner should be executed and filed in the United States Patent and Tradema rk Office. SIGNATURE of Practitioner of Record Signature Date Name Registration No. ( if applicable ) Telephone This collection of information is required by 1.31, 1.32 and 1.34. The information is required to obtain or retain a benefit by the public which is to file (and by the USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 15 minutes to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon 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, U.S. Patent and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. 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. AUTHORIZATION TO ACT IN A REPRESENTATIVE CAPACITY American LegalNet, Inc. www.FormsWorkFlow.com Privacy Act Statement The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with your submission of the attached form related to a patent application or patent. Accordingly, pursuant to the requirements of the Act, please be advised that: (1) the general authority for the collection of this information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary; and (3) the principal purpose for which the information is used by the U.S. Patent and Trademark Office is to process and/or examine your submission related to a patent application or patent. If you do not furnish the requested information, the U.S. Patent and Trademark Office may not be able to process and/or examine your submission, which may result in termination of proceedings or abandonment of the application or expiration of the patent. The information provided by you in this form will be subject to the following routine uses: 1.The information on this form will be treated confidentially to the extent allowed under theFreedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records fromthis system of records may be disclosed to the Department of Justice to determine whetherdisclosure of these records is required by the Freedom of Information Act.2.A record from this system of records may be disclosed, as a routine use, in the course ofpresenting evidence to a court, magistrate, or administrative tribunal, including disclosures toopposing counsel in the course of settlement negotiations.3.A record in this system of records may be disclosed, as a routine use, to a Member ofCongress submitting a request involving an individual, to whom the record pertains, when theindividual has requested assistance from the Member with respect to the subject matter of therecord.4.A record in this system of records may be disclosed, as a routine use, to a contractor of theAgency having need for the information in order to perform a contract. Recipients ofinformation shall be required to comply with the requirements of the Privacy Act of 1974, asamended, pursuant to 5 U.S.C. 552a(m).5.A record related to an International Application filed under the Patent Cooperation Treaty inthis system of records may be disclosed, as a routine use, to the International Bureau of theWorld Intellectual Property Organization, pursuant to the Patent Cooperation Treaty.6.A record in this system of records may be disclosed, as a routine use, to another federalagency for purposes of National Security review (35 U.S.C. 181) and for review pursuant tothe Atomic Energy Act (42 U.S.C. 218(c)).7.A record from this system of records may be disclosed, as a routine use, to the Administrator,General Services, or his/her designee, during an inspection of records conducted by GSA aspart of that responsibility to recommend improvements in records managementpractices and programs, under authority of 44 U.S.C. 2904 and 2906. Such disclosure shallbe made in accordance with the GSA regulations governing inspection of records for thispurpose, and any other relevant (i.e., GSA or Commerce) directive. Such disclosure shall notbe used to make determinations about individuals.8.A record from this system of records may be disclosed, as a routine use, to the public aftereither publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patentpursuant to 35 U.S.C. 151. Further, a record may be disclosed, subject to the limitations of 37CFR 1.14, as a routine use, to the public if the record was filed in an application whichbecame abandoned or in which the proceedings were terminated and which application isreferenced by either a published application, an application open to public inspection or anissued patent.9.A record from this system of records may be disclosed, as a routine use, to a Federal, State,or local law enforcement agency, if the USPTO becomes aware of a violation or potentialviolation of law or regulation. American LegalNet, Inc. www.FormsWorkFlow.com