POWER OF ATTORNEY 
ADMINISTRATOR/EXECUTOR 

1IN THE UNITED STATES PATENT AND TRADEMARK OFFICE 

In re patent of:  ___________________________________________________ (Name)
Patent No.:  _____________________________
Issued on:  ______________________________ (Date)
For:  ____________________________________________________________ (Item)

To the Commissioner of Patents and Trademarks: 

I, ______________________________________ (Name), as _____________________ (Administrator of the Estate or Executor of the last Will) of ______________________ (Deceased’s Name), who was a resident of __________________________________ (Give Complete Address), hereby appoint _______________________________ (Give Name, Full Address, and Phone Number) as my attorney and/or agent with full power of substitution, association, and revocation for the purpose of prosecuting Application Number:  __________________________ and for conducting all business in the Patent and Trademark Office in connection therewith. 

All telephone calls and all correspondence should be addressed to the above named attorney and/or agent as follows:
_______________________________________________________________ (Name)
_____________________________________________________ (Telephone Number)
_____________________________________________________ (Complete Address)

___________________________________                       ___________________
Signature							Date