[Date] Office of Enrollment and Discipline Mail Stop OED U.S. Patent and Trademark Office P.O.

Box 1450 Alexandria, VA 22313-1450 Re: Certificate of Good Standing

Dear OED: I would like to request a Certificate of Good Standing for myself. I am a registered patent attorney [Insert ‘patent agent’ if not a patent attorney] (# ) [Insert USPTO Bar Number] with an admission date of [Insert the date admitted to USPTO]. I have included a $10 check for the processing fee. Please mail the Certificate of Good Standing to me at: [Name] [Address] [City, State, Zip] Please let me know if you have any questions. Best regards,

[Name of Requester]

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