Change of Address

PLUS

Association of State and Provincial Psychology Boards

Voluntary Amendment Form Filing

Change Of Correspondence Address

The table below presents the data as entered.

Input Field	Entered
SERIAL NUMBER	86672585
MARK SECTION
MARK	PLUS
NEW CORRESPONDENCE ADDRESS
NEW ADDRESS
SIGNATURE SECTION
SIGNATORY FILE
ORIGINAL PDF FILE	HS_21614181254-123040992_._PLUS_Signed_Declaration_to_Perfect_Application_and_POA.pdf
CONVERTED PDF FILE(S) (2 pages)	\\TICRS\EXPORT16\IMAGEOUT16\866\725\86672585\xml3\CCA0002.jpg
	\\TICRS\EXPORT16\IMAGEOUT16\866\725\86672585\xml3\CCA0003.jpg
SIGNATORY NAME	Janet Orwig
SIGNATORY POSITION	Associate Executive Director
SIGNATURE	/Scott M. Oslick/
SIGNATORY NAME	Scott M. Oslick
SIGNATORY DATE	06/29/2015
SIGNATORY POSITION	Attorney of Record, DC/MD Bar member
SIGNATORY PHONE NUMBER	202-344-4676
AUTHORIZED SIGNATORY	YES
FILING INFORMATION SECTION
SUBMIT DATE	Mon Jun 29 12:34:31 EDT 2015
TEAS STAMP	USPTO/PRA-XXX.XXX.XX.XXX- 20150629123431478655-8667 2585-530d05fb76955db32908 7db1a9c61167455d872681c65 72fbfee839693116ebc0f6-N/ A-N/A-2015062912304099237 1

Change of Address [image/jpeg]

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