PATENT RECORDATION FORM

                                     COVER SHEET

Attorney Docket No. ___________________

To the Commissioner for Patents:  Please record the attached original document or copy thereof.  

1.  Name of conveying party(ies):

(1) ____________________________________

      Name of Party Assigning Rights

(2) ____________________________________

      Name of Party Assigning Rights

Additional name(s) of conveying party(ies) attached?      [  ] Yes [  ] No

2. Name and address of receiving party(ies):

Name: ________________________________

             Name of Receiving Party(ies)

Internal Address: ________________________ 

Street Address: _________________________

_____________________________________

3. Nature of Conveyance:

 [  ] Assignment [  ] Merger [  ] Security Agreement  

 [  ] Change of Name  [  ] Other

_________________________________________

If Other, Explain

Execution Date: _________________________

                              List Date(s) Document Executed

City ________________ State _____ ZIP _____

Additional name(s) & address(es) attached? 
[  ] Yes [  ] No

4A. Application No.(s)

       ______________________________________

Serial No.(s) - if Applicable

If this document is being filed together with a new application, the execution date(s) of the application is: ___________________________________          Execution Date(s) of Appln. - If applicable

Additional numbers attached? [  ] Yes [  ] No

4B. Patent No.(s)

  ______________________________________

Patent No.(s) - if Applicable

Additional numbers attached? [  ] Yes [  ] No

5. Name and address of party to whom

correspondence concerning document  should be

mailed:

6. Total number of applications and patents

   involved: [  ]

Name: __________________________               
                 Responsible Attorney

7. Total fee (37 CFR 3.41):.....$  ___________

Street Address:__________________________

______________________________________                  

City: _______________ State: _____ ZIP: _____

8. Method of Payment

   [  ] Enclosed

   [  ] The Commissioner is authorized to charge payment of any additional recording fees or credit any overpayment to deposit account No. __________________________.

DO NOT USE THIS SPACE

9. Statement and signature.

To the best of my knowledge and belief, the foregoing information is true and correct and any attached copy is a true copy of the original document.

Name of Person Signing

                                                                        ____________________

Signature                                                                                 Date

Total number of pages including cover sheet, attachments and document: [  ]