Your Name: ________________________________________________________
Address: ________________________________________________________
________________________________________________________
City/State/Zip: ________________________________________________________
Please supply the following information for each image you want a copy of:
State: _____________________ Accession Number: ________________________
Document Number: ______________ Land Office: _________________________
Patentee Last Name: ____________________________________________________
Patentee First Name: _____________________________ Middle Initial: ____
Number of copies of the document requested: __________
Certification requested (X): _______
______________________________________________________________________
Copy Fees: The first copy of each patent ordered from the Accession
Number supplied from this CD-ROM will cost $1.25 for a
single-page document. Additional copies of the same
patent may be obtained for $0.13 per page. The
certification fee is $0.25 per copy of the patent if
requested.
Please Note: A patent listing three (3) land descriptions will occur
as three (3) records in the CD-ROM database. However,
all three (3) records will have the same Accession
Number and refer to the same patent. To obtain a single
copy of the patent, list the Accession Number only once
on the order form.
Send requests to: Bureau of Land Management
Eastern States
7450 Boston Boulevard
Springfield VA 22153
Attn: GLO Records Access Team
OR
Fax (703) 440-1609
Print this form, fill out and mail in.