Mailing Provisional Application for Patent to United States Patent and Trademark Office

Size: px
Start display at page:

Download "Mailing Provisional Application for Patent to United States Patent and Trademark Office"

Transcription

1 Mailing Provisional Application for Patent to United States Patent and Trademark Office Introduction The method by which an applicant mails a patent application to the United States Patent and Trademark Office (USPTO) is exceedingly important. Under normal circumstances, the applicant will not receive the official filing receipt from the USPTO for approximately three months. The filing receipt will reveal the filing date and the serial number of the application. In the meantime, it is unknown if the application was lost in the mail and not received by the USPTO or if the application was not properly channeled within the USPTO. If the application is not properly channeled within the USPTO or if a sheet of the application is misplaced, the applicant will eventually receive a notice of incomplete application instead of a filing receipt. When the application is lost in the mail, no further communication will be received from the USPTO. Safeguards have been implemented to avoid the above problems and to allow the applicant use of the Patent Pending label immediately upon depositing the application with the U.S. Postal Service. Instructions for mailing in accordance with this procedure are set forth below. Complete Application The complete application for provisional patent includes six documents. These are listed below, in order from the top. 1. Post card 2. Check 3. Certificate of Express Mail 4. Provisional Application for Patent Cover Sheet 5. Specification 6. Drawings Each document must be either typed or neatly printed in black ink. The several documents are held together with a paper clip in the upper left corner. No other way is acceptable. The documents cannot be folded. Prior to mailing, the applicant must make copies of each document, including the check and both sides of the postcard. Each of these documents will be explained in detail as the instructions ensure. 1

2 Postcard The first document of the application is the postcard. The front of the post card is stamped and addressed back to the inventor, as shown below. John Q. Inventor 1234 Main Street Anytown, AZ On the back are listed all of the documents of the package, as shown below. Please acknowledge receipt of the following: Check in the amount of $ Certificate of Express Mail Application for Provisional Patent Cover Sheet pages of specification sheets of informal drawings The package will be received within the USPTO by a postal clerk. The clerk will examine the package to determine that all documents are included. The clerk will then stamp the card with the official USPTO stamp and mail back to the applicant. This should be received by the applicant within a couple of weeks. It is legal proof that the 2

3 complete application was received. The clerk will then send the application for routing within the USPTO. Check The check is made out to the Commissioner for Patents in the amount of the current filing fee. Filing fees are subject to periodic change. The current filing fee can be found on a computer by going to When the USPTO home page appears, click on the following in order: Site Index at the top of the page. F at the top of the new page. Fees, USPTO Current Fee Schedule at the top of the new page. When the next page appears, scroll down to Provisional application filing fee. Fees are listed under two headings: Fee and Small Entity Fee. Fee is the full filing free which is applicable to large entities, such as a corporation having many employees. Individual inventors and small business qualify for Small Entity Fee. Payment can be made by check, cashier's check or money order and must be made payable to "Director of the U.S. Patent and Trademark Office". Certificate of Express Mail The Certificate of Express Mail, in combination with the mailing label as will be discussed later, establish legal proof of the date on which the complete application was deposited with the U.S. Postal Service. A copy of the Certificate of Express Mail is duplicated on the next page for reference. Near the top of the page, opposite Applicant, the name of the applicant is entered. The applicant can choose either middle name or initial, but must be consistent throughout all documents. Opposite Title the name of the invention, as set forth as the heading of the specification, is entered. No entry is made opposite Serial Number. Within the body of the letter, the number of sheets of specification and the number of pages of drawings are entered. The applicant will sign on the line above Signature of Applicant. The name of the applicant is typed or printed below. Also required are Address and Phone number of the applicant. No other entries are made at this time. 3

4 IN THE UNITED STATES PATENT AND TRADEMARK OFFICE Applicant: Serial Number: Filed: Herewith Title: Commissioner for Patents P.O. Box 1450 Alexandria, VA Dear Sir: CERTIFICATE OF EPRESS MAIL Express Mail mailing label number: Date of Deposit: I hereby certify that the attached and executed Application For Provisional Patent Cover Sheet; application including pages specification and sheets informal drawings; check for appropriate fee; and a postcard, addressed and stamped are being deposited with the United States Postal Service Express Mail Post Office to Addressee in accordance with the provisions of 37 CFR 1.10, addressed to the Commissioner for Patents, P.O. Box 1450, Alexandria, VA on. Respectfully submitted, Signature of Applicant Name of Applicant: Address: Phone number: 4

5 Cover Sheet The Provisional Application for Patent Cover Sheet is a government document provided by the USPTO. It is subject to periodic revision. To obtain the current version, on the web go to When the USPTO home page appears, click on the following in order: Site Index at the top of the page. F at the top of the new page. Forms, USPTO When the FORMS page appears read the information at the top of the page. Then scroll down to and click on: PTO/SB/16 Provisional Application Patent Cover Sheet. The document will be presented in a form that can be downloaded and printed. The document includes two pages of application and one page setting forth privacy rights. The cover sheet is intended to be completed by the patent practitioner representing the applicant. Accordingly, it requires information concerning each. When not represented by counsel, the applicant is required to provide additional information and omit certain data. The cover sheet must either be typed or legibly printed in black ink. For purposes of illustration, the cover sheet which follows is completed for filing the previously described sample Hinge application. Each entry to be made by applicant will be explained. INVENTOR(S) If the application is the product of more than one inventor, the required data for each must be entered. TITLE OF THE INVENTION Enter the same title that appears on the application. Firm or Individual Name Check the box and enter the requested data. This is the contact name and address for the USPTO. ENCLOSED APPLICATION PARTS Specification check box and enter number of pages of written description. Drawings check box and enter number of sheets of drawings. METHOD OF PAYMENT Applicant claims small entity status check box. A check or money order is enclosed check box and enter amount in box above Total Fee Amount ($). The invention was made by an agency check box opposite No. At the bottom of the form enter required data next to SIGNATURE, TYPED or PRINTED NAME, TELEPHONE and DATE. 5

6 John Q. Inventor Phoenix, Arizona Hinge John Q. Inventor 1234 South Main Street Phoenix Arizona USA $

7 John Q. Inventor 23 July 2007 John Q. Inventor

8 Mailing Instructions Preliminary to Mailing It is absolutely necessary to make and keep copies of all the documents, including the check and both sides of the post card. Do not fold nor staple these papers. Put them away for safe keeping, as they may become absolutely in the future. The original documents are then assembled as a package in the order described above, fastened with a paper clip in the upper left corner and placed in an unsealed envelope. The envelope should be of the standard 9 12 size and the enclosed documents cannot be folded, stapled or otherwise assembled, except for a paper clip in the upper left corner. The envelope is addressed as set forth at the bottom of the first page of the cover sheet. As previously noted, the applicant must make copies of all documents, including the check and both sides of the postcard prior to mailing. Mailing Procedure The application is now taken to the local post office. The postal worker is informed that the envelope, with contents, is to be sent as Express Mail to Addressee. The postal worker will fasten a label to the envelope and give the applicant a copy of the postal label. A number will be present on the label. After receiving the mail label, remove the documents from the envelope and place the label number opposite Express Mail mailing label number on the Certificate of Express Mail and enter the current date opposite Date of Deposit and on the line at the end of the paragraph. The label number is also entered at the top of page 1 of the cover sheet on the line opposite Express Mail Label No. The envelope containing the complete application is then sealed and given to the postal clerk. For legal purposes, the application is considered Patent Pending on the date mailed, when sent in accordance with the foregoing. The applicant has immediate use of Patent Pending when exiting the post office. A copy of the Express Mailing Label given to the applicant is then paper clipped to the copies of the documents retained by the applicant. The date of mailing is kept in confidence by the applicant and divulged on a need-to-know basis. 8

Chapter 500 Receipt and Handling of Mail and Papers

Chapter 500 Receipt and Handling of Mail and Papers Chapter 500 Receipt and Handling of Mail and Papers 501 Filing Papers With the U.S. Patent and Trademark Office 502 Depositing Correspondence 502.01 Correspondence Transmitted by Facsimile 502.02 Correspondence

More information

Preissuance Submissions

Preissuance Submissions Preissuance Submissions General Question PS1100: What is the effective date for the preissuance submission provision in the AIA? The effective date for the preissuance submission provision in the AIA is

More information

BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA APPLICATION FOR CERTIFICATE OF EXEMPTION TO TRANSPORT HOUSEHOLD GOODS

BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA APPLICATION FOR CERTIFICATE OF EXEMPTION TO TRANSPORT HOUSEHOLD GOODS BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA APPLICATION FOR CERTIFICATE OF EXEMPTION TO TRANSPORT HOUSEHOLD GOODS NCUC Form CE-1 (Revised April 2013) Docket No. NOTE: Instructions

More information

Write Checks the Right Way

Write Checks the Right Way Write Checks the Right Way Guide G-220 Revised by Fahzy Abdul-Rahman 1 Cooperative Extension Service College of Agricultural, Consumer and Environmental Sciences CHECKS VS. OTHER PAYMENT METHODS Checks

More information

Mobile Banking FAQs. 1. What is First National Bank mobile banking?

Mobile Banking FAQs. 1. What is First National Bank mobile banking? Mobile Banking FAQs 1. What is First National Bank mobile banking? First National Bank offers its customers mobile access to account information through the use of a smartphone mobile device and the free

More information

Chapter 1800 Patent Cooperation Treaty

Chapter 1800 Patent Cooperation Treaty Chapter 1800 Patent Cooperation Treaty 1801 Basic Patent Cooperation Treaty (PCT) Principles 1802 PCT Definitions 1803 Reservations Under the PCT Taken by the United States of America 1804 [Reserved] 1805

More information

NOTICE OF CHANGE OF ADDRESS F-5. The District Court Filing Office is located on the first floor at: 75 Court Street Reno, NV 89501

NOTICE OF CHANGE OF ADDRESS F-5. The District Court Filing Office is located on the first floor at: 75 Court Street Reno, NV 89501 NOTICE OF CHANGE OF ADDRESS F-5 The District Court Filing Office is located on the first floor at: 75 Court Street Reno, NV 89501 NOTICE OF CHANGE OF ADDRESS PACKET F-5 INSTRUCTIONS FOR COMPLETING FORMS

More information

Quick Start Guide. Prioritized Examination for Non-Provisional Utility Applications

Quick Start Guide. Prioritized Examination for Non-Provisional Utility Applications Quick Start Guide Prioritized Examination for Non-Provisional Utility Applications Table of Contents 1. Introduction... 3 2. Basic Guidelines for Filing a Request for Prioritized Examination:... 3 3. Filing

More information

INSTRUCTIONS: FORECLOSING A TAX LIEN

INSTRUCTIONS: FORECLOSING A TAX LIEN INSTRUCTIONS: FORECLOSING A TAX LIEN You can use this packet if all of the following are true: You bought a tax lien. It has been three years since the original tax lien sale date but not later than ten

More information

STANISLAUS COUNTY SUPERIOR COURT http://www.stanct.org (209) 530-3100

STANISLAUS COUNTY SUPERIOR COURT http://www.stanct.org (209) 530-3100 STANISLAUS COUNTY SUPERIOR COURT http://www.stanct.org (209) 530-3100 Revised 7/12 Emancipation of Minor Packet This packet contains forms required to begin an emancipation proceeding in Stanislaus County

More information

POLICY AND PROCEDURES

POLICY AND PROCEDURES POLICY AND PROCEDURES ST. LOUIS COUNTY JUSTICE CENTER DEPARTMENT OF JUSTICE SERVICES NUMBER: 2001 SUBJECT: Inmate Mail ACA STANDARDS: 3-ALDF-3E-02; 4G-07; 5D-01, 02, 03, 04, 05, 06, 07, 08 DIRECTOR: Roy

More information

PRO SE MOTIONS FOR REIMBURSEMENT OF MEDICAL/DENTAL EXPENSES INSTRUCTIONS

PRO SE MOTIONS FOR REIMBURSEMENT OF MEDICAL/DENTAL EXPENSES INSTRUCTIONS PRO SE MOTIONS FOR REIMBURSEMENT OF MEDICAL/DENTAL EXPENSES INSTRUCTIONS FIRST PLEASE READ: It is highly recommended that a completed spreadsheet with copies of all unpaid medical/dental bills are mailed

More information

Patent and Trademark Searching

Patent and Trademark Searching Patent and Trademark Searching Provisional v. Non-provisional Applications Provisional Patent Application only serves as a place-holder and a patent will not issue from a Provisional Patent Application.

More information

Quick Start Guide. Customer Number Details Private Pair 7.1

Quick Start Guide. Customer Number Details Private Pair 7.1 Quick Start Guide Customer Number Details Private Pair 7.1 1. Search by Customer Number Details 1.1 Description Customers using the United States Patent and Trademark Office (USPTO) Private Patent Information

More information

Please contact 800.854.9846 if you have additional questions regarding your claim.

Please contact 800.854.9846 if you have additional questions regarding your claim. Upon receipt of this completed packet, Kinecta Federal Credit Union will research your claim. The Credit Union will resolve your claim within 10 business days or will contact you directly for additional

More information

PHARMACY TECHNICIAN APPLICATION & INSTRUCTIONS

PHARMACY TECHNICIAN APPLICATION & INSTRUCTIONS PHARMACY TECHNICIAN APPLICATION & INSTRUCTIONS IMPORTANT INFORMATION: Complete this application if you are applying to the Board for a pharmacy technician registration. You must answer all questions on

More information

Inventor s Oath or Declaration Examples Featuring Best Practices in Use of Inventor s Oath or Declaration Forms. Example Topic Recommended Forms

Inventor s Oath or Declaration Examples Featuring Best Practices in Use of Inventor s Oath or Declaration Forms. Example Topic Recommended Forms nventor s Oath or eclaration Examples Featuring Best Practices in Use of nventor s Oath or eclaration Forms The Office is providing four examples to aid applicants in determining which inventor s oath

More information

Chapter 300 Ownership and Assignment

Chapter 300 Ownership and Assignment Chapter 300 Ownership and Assignment 301 301.01 302 302.01 302.02 302.03 302.04 302.05 302.06 302.07 302.08 302.09 302.10 303 304-305 306 306.01 307 308 309 310 311 312 313 314 315 316 317 317.01 Ownership/Assignability

More information

CLOSING THE ESTATE PINAL COUNTY CLOSING THE ESTATE AS PERSONAL REPRESENTATIVE INSTRUCTIONS AND FORMS

CLOSING THE ESTATE PINAL COUNTY CLOSING THE ESTATE AS PERSONAL REPRESENTATIVE INSTRUCTIONS AND FORMS CLOSING THE ESTATE PINAL COUNTY CLOSING THE ESTATE AS PERSONAL REPRESENTATIVE INSTRUCTIONS AND FORMS Provided as a Public Service by Amanda Stanford Clerk of the Superior Court INFORMAL PROBATE CLOSING

More information

Beaverton School District

Beaverton School District Beaverton School District Code: EGAB-AR Adopted: 12/82, 8/94 Readopted: 4/1/00, 6/22/06 Orig. Code: 2000-7 MAIL AND DELIVERY SERVICES The Mail Center hours of operation are 6:30 a.m. to 4:30 p.m. The Mail

More information

AP Studio Art AP Studio Art Drawing and 2-D Design Portfolios

AP Studio Art AP Studio Art Drawing and 2-D Design Portfolios AP Studio Art AP Studio Art Drawing and 2-D Design Portfolios Friday, May 6, 2016 Last Day for AP Studio Art Portfolio Assembly for Drawing and 2-D Design The directions below apply only to the Section

More information

Quick Start Guide EFS-Web

Quick Start Guide EFS-Web Quick Start Guide EFS-Web Updated August 17, 2008 Introduction Welcome to EFS-Web, the s safe, simple, and secure means of electronically submitting patent applications and documents. This Quick Start

More information

United States Patent and Trademark Office (USPTO) Patent e-commerce. Essentials Systems Support

United States Patent and Trademark Office (USPTO) Patent e-commerce. Essentials Systems Support United States Patent and Trademark Office (USPTO) Patent e-commerce Essentials Systems Support United States Patent and Trademark Office Mailstop EBC Commissioner for Patents PO Box 1450 Alexandria, VA

More information

MOTION TO CHANGE CUSTODY

MOTION TO CHANGE CUSTODY FD/FOC 4018 MOTION TO CHANGE CUSTODY USE THIS SET OF FORMS IF: You still have at least one child on this case that is under 18 years old You want to change physical custody of the child(ren) in your case

More information

UNITED STATES PATENT AND TRADEMARK OFFICE (USPTO)

UNITED STATES PATENT AND TRADEMARK OFFICE (USPTO) PCT Applicant s Guide National Phase National Chapter US Page 1 US UNITED STATES PATENT AND TRADEMARK OFFICE (USPTO) AS DESIGNATED (OR ELECTED) OFFICE CONTENTS THE ENTRY INTO THE NATIONAL PHASE SUMMARY

More information

CONSIDERATION OF SUGGESTIONS

CONSIDERATION OF SUGGESTIONS CONSIDERATION OF SUGGESTIONS INTRODUCTION Every year we receive many letters proposing ideas for the Company s use. We appreciate this interest in BD and want to thank each person who has taken the time

More information

Web Time Entry At Lindsey Wilson College. Approver s Guide

Web Time Entry At Lindsey Wilson College. Approver s Guide Web Time Entry At Lindsey Wilson College Approver s Guide Log On Banner Web. Click on Employee Services. Instructions Welcome to the Main Menu page. The Employee Menu appears. Click on Time Sheet. Primary

More information

IRA Distribution Request Form Instructions

IRA Distribution Request Form Instructions Vanguard Retirement Resource Center IRA Distribution Request Form Instructions 1. Account Owner Information The information you provide in this section should be identical to the registration information

More information

USPTO Patent e-commerce Programs

USPTO Patent e-commerce Programs USPTO Patent e-commerce Programs Essentials Systems Support USPTO Patent e-commerce Programs Essentials Systems Support Customer Number Patent EFS-Web PKI Security PAIR Digital Certificate Management TABLE

More information

BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA

BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA NCUC Form CE-2 (Revised April 2013) APPLICATION TO SELL, ASSIGN, PLEDGE, TRANSFER, LEASE, MERGE, OR ACQUIRE EXISTING CERTIFICATE OF

More information

MAILROOM POLICIES & PROCEDURES

MAILROOM POLICIES & PROCEDURES MAILROOM POLICIES & PROCEDURES Policy Id: Bus.014 Mailroom Policies and Procedures Contact: Michael Merseburg, Mailroom Coordinator mmerseburg@jjay.cuny.edu - Ext. 8532 Gary Zaragovitch-Graphics graphics@jjay.cuny.edu

More information

GENERAL INFORMATION/INSTRUCTIONS. Application for Chiropractic Acupuncture Certification

GENERAL INFORMATION/INSTRUCTIONS. Application for Chiropractic Acupuncture Certification Department of Health Board of Chiropractic Medicine 4052 Bald Cypress Way, Bin #C07 Tallahassee, FL 32399-3257 GENERAL INFORMATION/INSTRUCTIONS Application for Chiropractic Acupuncture Certification HOW

More information

$18,345,000* County of Pitt, North Carolina General Obligation Community College Bonds Series 2015

$18,345,000* County of Pitt, North Carolina General Obligation Community College Bonds Series 2015 Notice of Sale and Bid Form Note: Bonds are to be awarded on a True Interest Cost (TIC) basis as described herein. No bid for fewer than all of the bonds offered or for less than 100% of the aggregate

More information

UNITED STATES PATENT AND TRADEMARK OFFICE OFFICE ACTION

UNITED STATES PATENT AND TRADEMARK OFFICE OFFICE ACTION SERIAL NO: 76/689338 UNITED STATES PATENT AND TRADEMARK OFFICE MARK: IDEA CORRESPONDENT ADDRESS: DAVID M. KELLY Finnegan, Henderson, Farabow, Garrett 901 New York Avenue, N.W. Washington, DC 20001-4413

More information

IMPORTANT NOTICE REGARDING THE LANDSCAPE ARCHITECTURAL REGISTRATION EXAMINATION ("L.A.R.E.")

IMPORTANT NOTICE REGARDING THE LANDSCAPE ARCHITECTURAL REGISTRATION EXAMINATION (L.A.R.E.) IMPORTANT NOTICE REGARDING THE LANDSCAPE ARCHITECTURAL REGISTRATION EXAMINATION ("L.A.R.E.") This notice supersedes the information on the application form regarding applying for the Landscape Architectural

More information

FAIRFAX CIRCUIT COURT ATTORNEY ISSUED SUBPOENA GUIDELINE PROCEDURES AND FORMS

FAIRFAX CIRCUIT COURT ATTORNEY ISSUED SUBPOENA GUIDELINE PROCEDURES AND FORMS FAIRFAX CIRCUIT COURT ATTORNEY ISSUED SUBPOENA GUIDELINE PROCEDURES AND FORMS ATTORNEY ISSUED SUBPOENAS If attendance is desired in a civil proceeding pending in a court or at a deposition in connection

More information

Comments on Trademarks Next Generation Information Technology Initiative

Comments on Trademarks Next Generation Information Technology Initiative The Honorable Lynne Beresford Commissioner for Trademarks United States Patent and Trademark Office P.O. Box 1450 Alexandria, VA 22313-1450 Comments on Trademarks Next Generation Dear Commissioner Beresford:

More information

Office of the Fiduciary Supervisor Kanawha County Commission P.O. Box 3627, Charleston, WV 25336 (304) 357-0125

Office of the Fiduciary Supervisor Kanawha County Commission P.O. Box 3627, Charleston, WV 25336 (304) 357-0125 Office of the Fiduciary Supervisor Kanawha County Commission P.O. Box 3627, Charleston, WV 25336 (304) 357-0125 Step 3: The Short Form Settlement Dear Personal Representative, Date: RE: Estate of: The

More information

State of New York Supreme Court, Appellate Division Third Judicial Department P.O. Box 7288, Capitol Station Albany, NY 12224-0288

State of New York Supreme Court, Appellate Division Third Judicial Department P.O. Box 7288, Capitol Station Albany, NY 12224-0288 State of New York Supreme Court, Appellate Division Third Judicial Department P.O. Box 7288, Capitol Station Albany, NY 12224-0288 Robert D. Mayberger Clerk of the Court (518) 471-4777 fax (518) 471-4750

More information

The Boston Patent Law Association Electronic Business with the U.S. Patent Office and World Intellectual Property Organization (WIPO)

The Boston Patent Law Association Electronic Business with the U.S. Patent Office and World Intellectual Property Organization (WIPO) The Boston Patent Law Association Electronic Business with the U.S. Patent Office and World Intellectual Property Organization (WIPO) Maria Eliseeva, Esq. HOUSTON ELISEEVA LLP Lexington, MA September 3,

More information

RESPONSE TO FINAL OFFICE ACTION MAILED NOVEMBER 21, 2012 S/N: 13/618,718 ATTY. DKT. NO.: PRS004CIPCON3

RESPONSE TO FINAL OFFICE ACTION MAILED NOVEMBER 21, 2012 S/N: 13/618,718 ATTY. DKT. NO.: PRS004CIPCON3 Page 1 of 12 IN THE UNITED STATES PATENT AND TRADEMARK OFFICE In re Application of: David Kalokitis Serial No.: 13/618,718 Confirmation No.: 1832 Filed: September 14, 2012 Atty. Docket No.: PRS004CIPCON3

More information

Insurance bill payment made easy

Insurance bill payment made easy Insurance bill payment made easy for our property & casualty customers Whether you have your personal insurance, business insurance, or (hopefully) both with Harleysville, we give you 4 convenient options

More information

ADVANCED PRACTICE REGISTERED NURSE (APRN) AUTHORIZATION APPLICATION AND INSTRUCTIONS

ADVANCED PRACTICE REGISTERED NURSE (APRN) AUTHORIZATION APPLICATION AND INSTRUCTIONS ADVANCED PRACTICE REGISTERED NURSE (APRN) AUTHORIZATION APPLICATION AND INSTRUCTIONS APRN Authorization Requirements [Massachusetts General Laws Chapter 112, section 80B & 244 CMR 4.13 & 9.04 (1), (2)

More information

[NPINumber] [Date] «PROVIDERNAME» «PROVIDERADDRESS» «PROVIDERCITYSTATEZIP» ATTENTION: COMPLIANCE. Subject: Additional Documentation Request (ADR)

[NPINumber] [Date] «PROVIDERNAME» «PROVIDERADDRESS» «PROVIDERCITYSTATEZIP» ATTENTION: COMPLIANCE. Subject: Additional Documentation Request (ADR) [Date] [NPINumber] «PROVIDERNAME» «PROVIDERADDRESS» «PROVIDERCITYSTATEZIP» ATTENTION: COMPLIANCE Subject: Additional Documentation Request (ADR) Dear Medicare Provider: The Centers for Medicare & Medicaid

More information

Switching to Peninsula CU

Switching to Peninsula CU Switching to Peninsula CU Joining Peninsula is easy. Simply follow the steps listed and you will be on your way. Establish an Account at Peninsula Apply for a Savings and Checking Account at the Peninsula

More information

AUSTIN CPA CHAPTER/CPE FOUNDATION SCHOLARSHIP PROGRAM GUIDELINES AND INSTRUCTIONS

AUSTIN CPA CHAPTER/CPE FOUNDATION SCHOLARSHIP PROGRAM GUIDELINES AND INSTRUCTIONS AUSTIN CPA CHAPTER/CPE FOUNDATION SCHOLARSHIP PROGRAM GUIDELINES AND INSTRUCTIONS The Austin CPA Chapter/CPE Foundation established a scholarship program whose purpose is to provide scholarship assistance

More information

FILING GUIDE SERVICE OF PROCESS

FILING GUIDE SERVICE OF PROCESS Tennessee Department of State Division of Business Services FILING GUIDE SERVICE OF PROCESS Secretary of State 2005 Revised Edition Tennessee Department of State Division of Business Services MISSION The

More information

HOW TO OBTAIN A NEW CONTRACTOR LICENSE

HOW TO OBTAIN A NEW CONTRACTOR LICENSE HOW TO OBTAIN A NEW CONTRACTOR LICENSE These instructions apply to new licenses only. If you wish to add a classification or a qualifying party to an existing license, please see HOW TO ADD A CLASSIFICATION

More information

PCT PRACTICE International Applications Filed Prior to January 1, 2004

PCT PRACTICE International Applications Filed Prior to January 1, 2004 International Applications Filed Prior to January 1, 2004 I. Introduction The PCT (Patent Cooperation Treaty) is an international agreement for the purpose of unifying and simplifying the procedures for

More information

United States Patent and Trademark Office. ACTION: Proposed collection; comment request. SUMMARY: The United States Patent and Trademark Office

United States Patent and Trademark Office. ACTION: Proposed collection; comment request. SUMMARY: The United States Patent and Trademark Office This document is scheduled to be published in the Federal Register on 10/21/2014 and available online at http://federalregister.gov/a/2014-24967, and on FDsys.gov 3510-16-P DEPARTMENT OF COMMERCE United

More information

AutoCAD LT Product Portfolio Rebate Promotion Frequently Asked Questions ANZ Final (7 May 2013)

AutoCAD LT Product Portfolio Rebate Promotion Frequently Asked Questions ANZ Final (7 May 2013) AutoCAD LT Product Portfolio Rebate Promotion Frequently Asked Questions ANZ Final (7 May 2013) 1. What is the AutoCAD LT and AutoCAD Inventor LT Suite Upgrade Seat ( AutoCAD LT Product Portfolio ) Rebate

More information

Instructions for Completing the ECFMG International Credentials Services (EICS) Application ECFMG International Credentials Services (EICS)

Instructions for Completing the ECFMG International Credentials Services (EICS) Application ECFMG International Credentials Services (EICS) THE EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES INTERNATIONAL CREDENTIALS SERVICES The Health Professions Council of South Africa requires that physicians seeking medical licensure/registration

More information

Quick Start Guide. EFS-Web epetitions

Quick Start Guide. EFS-Web epetitions Quick Start Guide EFS-Web epetitions Table of Contents Introduction... 3 Basic Guidelines for Filing epetitions:... 4 1. epetition Filing Requirements: Request for Withdrawal as Attorney or Agent of Record

More information

USPTO Fees - FY 2003

USPTO Fees - FY 2003 USPTO Fees - FY 2003 UNITED STATES PATENT AND TRADEMARK OFFICE Effective January 1, 2003 Any fee amount paid on or after January 1, 2003, must be paid in the revised amount. The fees subject to reduction

More information

INSTRUCTIONS FOR ESTABLISHING A WRONGFUL DEATH TRUST

INSTRUCTIONS FOR ESTABLISHING A WRONGFUL DEATH TRUST INSTRUCTIONS FOR ESTABLISHING A WRONGFUL DEATH TRUST These instructions are intended as a guideline only and should not be relied upon as a comprehensive list of duties in a wrongful death trust. If you

More information

Ontario Woodlot Association

Ontario Woodlot Association Ontario Woodlot Association Membership Management System (MMS) User Manual MMS User Manual Table of Contents (v3) This user manual provides a general overview of the Association s online Membership Management

More information

220 Burnham Street South Windsor, CT 06074 Vox 888-255-7293 Fax 860-289-0055 NEW YORK MEDICAID DENTAL ELECTRONIC CLAIMS ENROLLMENT REGISTRATION

220 Burnham Street South Windsor, CT 06074 Vox 888-255-7293 Fax 860-289-0055 NEW YORK MEDICAID DENTAL ELECTRONIC CLAIMS ENROLLMENT REGISTRATION NEW YORK MEDICAID DENTAL ELECTRONIC CLAIMS ENROLLMENT REGISTRATION PAYER ID NUMBER CKNY1 (to be used ONLY by Dental Offices whose category of service is 0200) CKNY2 (to be used ONLY by Dental Clinics)

More information

Mobile Check Deposit Frequently Asked Questions

Mobile Check Deposit Frequently Asked Questions Deposit Frequently Asked Questions What is Deposit is a service that allows members to electronically transmit an image of their check using an iphone, ipad, Android phone, or Android Tablet for deposit

More information

Cash Letter Deposit Service Guide

Cash Letter Deposit Service Guide Cash Letter Deposit Service Guide July 2005 Table of Contents Cash Letter Deposit Service Overview...3 Introduction...3 Cash Letter Pre-Encoded Deposit Workflow...4 Cash Letter Un-Encoded Deposit Workflow...5

More information

Federal Write-in Absentee Ballot (FWAB)

Federal Write-in Absentee Ballot (FWAB) Federal Write-in Absentee Ballot (FWAB) For any questions about this form, consult the Voting Assistance Guide available in hard copy or For absent Uniformed Service members, their families, and citizens

More information

PROCEDURES AND INSTRUCTIONS FOR FILING A SMALL CLAIMS PROPERTY TAX VALUATION APPEAL IN THE ARIZONA TAX COURT

PROCEDURES AND INSTRUCTIONS FOR FILING A SMALL CLAIMS PROPERTY TAX VALUATION APPEAL IN THE ARIZONA TAX COURT Self-Service Center PROCEDURES AND INSTRUCTIONS FOR FILING A SMALL CLAIMS PROPERTY TAX VALUATION APPEAL IN THE ARIZONA TAX COURT Use the forms in this package only if you can say "yes" to ALL FIVE (5)

More information

PFCU MOBILE DEPOSIT TERMS AND CONDITIONS

PFCU MOBILE DEPOSIT TERMS AND CONDITIONS PFCU MOBILE DEPOSIT TERMS AND CONDITIONS 1. Service and Service Terms. The following terms and conditions apply to Portland Federal Credit Union (PFCU) MOBILE DEPOSIT SERVICE ( Service ) that PFCU may

More information

Cardholder s Guide Policy for Disputed POS Transactions

Cardholder s Guide Policy for Disputed POS Transactions Cardholder s Guide Policy for Disputed POS Transactions Original Publication Revisions This document is protected under the trade secret and copyright laws as the property of Metavante Corporation. Year

More information

8.0.0.0.0 Accounts Receivable. I. Overview Definitions and Abbreviations. Equipment and Supplies Required

8.0.0.0.0 Accounts Receivable. I. Overview Definitions and Abbreviations. Equipment and Supplies Required 8.0.0.0.0 Accounts Receivable I. Overview Definitions and Abbreviations Equipment and Supplies Required Page 1 of 36 Revised October 2015 Version 4 II. Job Position(s) Accounts Receivable Clerk Page 2

More information

IN A CIVIL LAWSUIT ALASKA COURT SYSTEM OCTOBER 2014. Do NOT use these instructions in Small Claims or Eviction Cases.

IN A CIVIL LAWSUIT ALASKA COURT SYSTEM OCTOBER 2014. Do NOT use these instructions in Small Claims or Eviction Cases. IN A CIVIL LAWSUIT Do NOT use these instructions in Small Claims or Eviction Cases. OCTOBER 2014 ALASKA COURT SYSTEM Contents 1. Personal Service by Process Server 1 2. Service by Certified Mail 3 3. Service

More information

HOW TO PLACE AN INITIATIVE ON A CITY BALLOT

HOW TO PLACE AN INITIATIVE ON A CITY BALLOT HOW TO PLACE AN INITIATIVE ON A CITY BALLOT 1. Prepare the Text of the Initiative. (Below you will find a sample initiative. Do not merely copy the sample. The Text of your initiative must be tailored

More information

COMMONWEALTH OF VIRGINIA BOARD OF SOCIAL WORK

COMMONWEALTH OF VIRGINIA BOARD OF SOCIAL WORK Website - http://www.dhp.virginia.gov/social ELECTRONIC APPLICATION INSTRUCTIONS FOR LICENSURE AS A CLINICAL SOCIAL WORKER (LCSW) BY EXAMINATION Supporting documentation: Upon completion of the online

More information

OED Update: Statistics and Case Law at OED

OED Update: Statistics and Case Law at OED OED Update: Statistics and Case Law at OED William R. Covey Deputy General Counsel and Director Office of Enrollment and Discipline United States Patent and Trademark Office Total Number of OED Disciplinary

More information

UNITED STATES PATENT AND TRADEMARK OFFICE BEFORE THE PATENT TRIAL AND APPEAL BOARD. ABB INC. Petitioner v. ROY-G-BIV CORPORATION Patent Owner

UNITED STATES PATENT AND TRADEMARK OFFICE BEFORE THE PATENT TRIAL AND APPEAL BOARD. ABB INC. Petitioner v. ROY-G-BIV CORPORATION Patent Owner Filed on behalf of ABB Inc. By: (Reg. No. 46,921) rick.mcleod@klarquist.com Michael D. Jones (Reg. No. 41,879) michael.jones@klarquist.com Klarquist Sparkman LLP UNITED STATES PATENT AND TRADEMARK OFFICE

More information

TRADING PROCESS FOR OVER THE COUNTER TRADING PLATFORM

TRADING PROCESS FOR OVER THE COUNTER TRADING PLATFORM TRADING PROCESS FOR OVER THE COUNTER TRADING PLATFORM PURPOSE OF THIS DOCUMENT The purpose of this document is to explain the trading process for the Hlumisa and Eyomhlaba shares using the online trading

More information

COVER LETTER. The enclosed Articles of Domestication of a Non-U.S. Entity and fee(s) are submitted for filing.

COVER LETTER. The enclosed Articles of Domestication of a Non-U.S. Entity and fee(s) are submitted for filing. COVER LETTER TO: SUBJECT: Name of Limited Liability Company Dear Sir or Madam: The enclosed Articles of Domestication of a Non-U.S. Entity and fee(s) are submitted for filing. Please return all correspondence

More information

Check Hold Policy Disclosure Statement

Check Hold Policy Disclosure Statement Check Hold Policy Disclosure Statement Our policy is to delay the availability of funds that you deposit in your account. During the delay, you may not withdraw the funds in cash or in the form of a withdrawal

More information

HEARING BOARDS 444 SW 2 nd Avenue, 7 th Floor Miami, Florida 33130 Telephone 305-416-2030 Fax 305-416-2035 www.miamigov.

HEARING BOARDS 444 SW 2 nd Avenue, 7 th Floor Miami, Florida 33130 Telephone 305-416-2030 Fax 305-416-2035 www.miamigov. HEARING BOARDS 444 SW 2 nd Avenue, 7 th Floor Miami, Florida 33130 Telephone 305-416-2030 Fax 305-416-2035 www.miamigov.com/hearing_boards SPECIAL EXCEPTION Welcome to Hearing Boards! This application

More information

IN THE SUPERIOR COURT OF THE STATE OF ARIZONA IN AND FOR THE COUNTY OF PIMA

IN THE SUPERIOR COURT OF THE STATE OF ARIZONA IN AND FOR THE COUNTY OF PIMA IN THE SUPERIOR COURT OF THE STATE OF ARIZONA IN AND FOR THE COUNTY OF PIMA IN RE THE MATTER OF ELECTRONIC ) FILING AND SERVICE OF PLEADINGS ) ADMINISTRATIVE IN PROBATE CASES ) ORDER NO. 2004-09 ) 1. Authorization

More information

APPLICATION FOR DOMESTIC RECIPROCITY LICENSE. The State Board of Cosmetology may grant license by reciprocity, without examination, if:

APPLICATION FOR DOMESTIC RECIPROCITY LICENSE. The State Board of Cosmetology may grant license by reciprocity, without examination, if: 2401 NW 23rd Street, Suite 84 Reciprocity Department 405.522.7620 Fax 405.521.2440 MARY FALLIN GOVERNOR SHERRY G. LEWELLING EXECUTIVE DIRECTOR APPLICATION FOR DOMESTIC RECIPROCITY LICENSE The State Board

More information

UNITED STATES PATENT AND TRADEMARK OFFICE UNITED STATES DEPARTMENT OF COMMERCE

UNITED STATES PATENT AND TRADEMARK OFFICE UNITED STATES DEPARTMENT OF COMMERCE UNITED STATES PATENT AND TRADEMARK OFFICE UNITED STATES DEPARTMENT OF COMMERCE United States Patent and Trademark Office Address: COMMISSIONER FOR PATENTS P.O. Box 1450 Alexandria, Virginia 22313-1450

More information

Licensure as a Pharmacy Technician

Licensure as a Pharmacy Technician *** Submit this page with application *** ***FOR OFFICE USE ONLY*** Receipt # ID # Issue Date License # State of Rhode Island Board of Pharmacy Room 205 3 Capitol Hill Providence, RI 02908-5097 Instructions

More information

Nursing Student Loan Forgiveness Program Renewal Packet

Nursing Student Loan Forgiveness Program Renewal Packet Nursing Student Loan Forgiveness Program Renewal Packet CONTAINS: Renewal Information, Participant Renewal & Payment Form, Loan Principal Certification (Renewal), Renewal Packet Checklist Florida Department

More information

OTHER PERSON S ELECTION DAY EXPENDITURES REPORT INSTRUCTIONS GENERAL INFORMATION

OTHER PERSON S ELECTION DAY EXPENDITURES REPORT INSTRUCTIONS GENERAL INFORMATION OTHER PERSON S ELECTION DAY EXPENDITURES REPORT INSTRUCTIONS READ ALL INSTRUCTIONS CAREFULLY AND REMOVE INSTRUCTION PAGE BEFORE FILING. TYPE OR PRINT LEGIBLY IN BLACK INK. GENERAL INFORMATION This report

More information

Iowa Marital and Family Therapist (MFT)

Iowa Marital and Family Therapist (MFT) Iowa Marital and Family Therapist (MFT) 2015 Application for Education Review This application form is interactive. Download the form to your computer to fill it out. 3 TERRACE WAY GREENSBORO, NORTH CAROLINA

More information

MEDICAL LIEN PACKET. With You from Injury to Recovery

MEDICAL LIEN PACKET. With You from Injury to Recovery MEDICAL LIEN PACKET With You from Injury to Recovery Table of Contents RCW 60.44.010-60.44.060...1 How to Complete a Lien...2 Costs and Procedures...3 Where to File a Lien...4 Notice of Claim Form...5

More information

INSTRUCTIONS FOR PREPARING CASH TRANSMITTALS AND WEB DEPOSITS

INSTRUCTIONS FOR PREPARING CASH TRANSMITTALS AND WEB DEPOSITS INSTRUCTIONS FOR PREPARING CASH TRANSMITTALS AND WEB DEPOSITS It is the responsibility of all individuals receiving money on behalf of the University to be aware of and to comply with the following procedures

More information

GENERAL INSTRUCTIONS

GENERAL INSTRUCTIONS UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK IN RE: SATYAM COMPUTER SERVICES LTD. SECURITIES LITIGATION No. 09-MD-2027-BSJ PROOF OF CLAIM AND RELEASE TO BE ELIGIBLE TO RECEIVE A SHARE OF

More information

APPLICATION FOR DETERMINATION OF ELIGIBILTY FOR MILITARY TUITION BENEFIT INSTRUCTIONS

APPLICATION FOR DETERMINATION OF ELIGIBILTY FOR MILITARY TUITION BENEFIT INSTRUCTIONS APPLICATION FOR DETERMINATION OF ELIGIBILTY FOR MILITARY TUITION BENEFIT Under North Carolina General Statutes Section 116-143.3, certain members of the armed services and their dependent relative(s) may

More information

Gila County Attorney s Office Bad Check Program Guidebook

Gila County Attorney s Office Bad Check Program Guidebook Gila County Attorney s Office Bad Check Program Guidebook INSUFFICIENT FUNDS ACCOUNT CLOSED Gila County Attorney s Office Bad Check Program 714 S. Beeline Hwy., Suite 202 Payson, AZ 85541 BAD CHECK PROGRAM

More information

PETITION TO PROBATE WILL IN SOLEMN FORM INSTRUCTIONS

PETITION TO PROBATE WILL IN SOLEMN FORM INSTRUCTIONS I. Specific Instructions PETITION TO PROBATE WILL IN SOLEMN FORM INSTRUCTIONS 1. This form is to be used when filing a petition to probate will in solemn form pursuant to O.C.G.A. 53-5-20 et seq. 2. It

More information

Cash Handling Questionnaire

Cash Handling Questionnaire Cash Handling Questionnaire Internal Control Questionnaire Question Yes No N/A Remarks Because of the relatively high risk associated with transactions involving cash, universities should have a cash management

More information

STATE OF FLORIDA BOARD OF MASSAGE THERAPY APPLICATION FOR COLON HYDROTHERAPY UPGRADE TO MASSAGE THERAPIST LICENSE WITH INSTRUCTIONS

STATE OF FLORIDA BOARD OF MASSAGE THERAPY APPLICATION FOR COLON HYDROTHERAPY UPGRADE TO MASSAGE THERAPIST LICENSE WITH INSTRUCTIONS STATE OF FLORIDA BOARD OF MASSAGE THERAPY APPLICATION FOR COLON HYDROTHERAPY UPGRADE TO MASSAGE THERAPIST LICENSE WITH INSTRUCTIONS Board of Massage Therapy 4052 Bald Cypress Way, Bin # C-06 Tallahassee,

More information

2. Is the mail log prepared by someone who does not participate in any other aspects of the revenue receipts process?

2. Is the mail log prepared by someone who does not participate in any other aspects of the revenue receipts process? CASH AND CHECK HANDLING SELF ASSESSMENT Because of the relatively high risk associated with transactions involving cash, universities need to have a cash management program to safeguard cash and ensure

More information

EOCSC 2015-2016 Spouse Scholarship Application

EOCSC 2015-2016 Spouse Scholarship Application EOCSC 2015-2016 Spouse Scholarship Application General Information/Criteria: 1. The Ellsworth Officers and Civilians Spouses Club (EOCSC) offers merit-based scholarships to eligible military and civilian

More information

CLAIM FORM THE FOLLOWING DOCUMENTS ARE REQUIRED TO BE FILED WITH THIS CLAIM FORM:

CLAIM FORM THE FOLLOWING DOCUMENTS ARE REQUIRED TO BE FILED WITH THIS CLAIM FORM: Trex Company, Inc. Trex Class Action Settlement ATTN: Trex Surface Flaking Litigation P.O. Box 921759 Norcross, GA 30010-1759 Toll Free Line: 1-866-241-4396 Complete this form if you are submitting a claim

More information

WAYFINDING SIGNING FABRICATION CONTRACT

WAYFINDING SIGNING FABRICATION CONTRACT WAYFINDING SIGNING FABRICATION CONTRACT AGREEMENT FOR SERVICES This Agreement for Services ( Agreement ) is entered into this 6 th day of September, 2011, (hereinafter referred to as the effective date

More information

SWITCH KIT. Switching is as easy as 1-2-3

SWITCH KIT. Switching is as easy as 1-2-3 SWITCH KIT Switching is as easy as 1-2-3 1. Open up a checking and/or savings account 2. We will help you complete the necessary forms to have your automatic deposits and withdrawals switched to your new

More information

Idea Submission Letter

Idea Submission Letter Idea Submission Letter Introduction................................................................... 2 Lavi Industries Procedure For Considering Your Idea................................ 2 Stage 1: Preliminary

More information

Other You must complete a W-8BEN form. Please call the phone number above to obtain a form.

Other You must complete a W-8BEN form. Please call the phone number above to obtain a form. Joint - Custodial - Trust - Will be presumed to be joint tenants with rights of survivorship unless restricted by applicable state law or otherwise indicated. Aminor is the beneficial owner of the account

More information

SUPREME COURT, CIVIL BRANCH New York County 60 Centre Street, New York, N.Y. 10007. HELP CENTER Room 116 646-386-3025

SUPREME COURT, CIVIL BRANCH New York County 60 Centre Street, New York, N.Y. 10007. HELP CENTER Room 116 646-386-3025 SUPREME COURT, CIVIL BRANCH New York County 60 Centre Street, New York, N.Y. 10007 HELP CENTER Room 116 646-386-3025 How to Respond to a Summons and Complaint Note: All persons involved in a lawsuit should

More information

INFORMATIONAL LETTER NO. 69

INFORMATIONAL LETTER NO. 69 INFORMATIONAL LETTER NO. 69 TO: All Insurance Companies Licensed To Transact Business In West Virginia, All Licensed Nonresident Brokers and Other Interested Parties DATE: May 1990 RE: Agent Licensing

More information

Introducer Pack. COUNTRYWIDE MONEY Compare

Introducer Pack. COUNTRYWIDE MONEY Compare Introducer Pack COUNTRYWIDE MONEY Compare This agreement is made between Countrywide Money the broker and an ag ent the agent and shall take effect from the date on which the agreement is signed by the

More information

SURPLUS LINES BROKER TRANSACTION AND TAX REPORTS

SURPLUS LINES BROKER TRANSACTION AND TAX REPORTS DEPARTMENT OF INSURANCE STATE OF ARIZONA Insurance Tax Unit 2910 North 44 th Street, Suite 210 Phoenix, Arizona 85018-7269 Phone: (602) 364-3246 Fax: (602) 364-3989 Instructions for filing SURPLUS LINES

More information