[Date]

Office of Enrollment and DisciplineMail Stop OEDU.S. Patent and Trademark OfficeP.O. Box 1450Alexandria, 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]