Teas Change of Owner Address

LIBERTY ADVANCED DAYONE DISABILITY

LIBERTY MUTUAL INSURANCE COMPANY

Change Of Owner's Address

PTO Form 2197 (Rev 09/2005)

OMB No. 0651-0056 (Exp 09/30/2011)

Change Of Owner's Address

The table below presents the data as entered.

Input Field	Entered
SERIAL NUMBER	76033790
REGISTRATION NUMBER	2492242
LAW OFFICE ASSIGNED	LAW OFFICE 104
MARK SECTION
MARK	LIBERTY ADVANCED DAYONE DISABILITY
OWNER SECTION (current)
NAME	LIBERTY MUTUAL INSURANCE COMPANY
STREET	175 BERKELEY STREET
CITY	BOSTON
STATE	Massachusetts
ZIP/POSTAL CODE	02117
COUNTRY	US
NEW OWNER ADDRESS
STREET	175 Berkeley Street
CITY	Boston
STATE	Massachusetts
ZIP/POSTAL CODE	02116
COUNTRY	United States
SIGNATURE SECTION
SIGNATURE	/Lisa Parker Gates/
SIGNATORY NAME	Lisa Parker Gates
SIGNATORY DATE	09/08/2011
SIGNATORY POSITION	Attorney of record, Illinois bar member
FILING INFORMATION SECTION
SUBMIT DATE	Thu Sep 08 11:48:32 EDT 2011
TEAS STAMP	USPTO/COA-XX.XX.XX.XXX-20 110908114832881537-785698 28-4806f29cbbc609598323b8 db986d28904-N/A-N/A-20110 908113311044493

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