Change Address or Representation Form

SKINLIFT

Azadeh Shirazi, MD

Change Address or Representation Form

Under the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number.
PTO Form 2300 (Rev 02/2020)

OMB No. 0651-0051 (Exp 11/30/2020)

Change Address or Representation Form

The table below presents the data as entered.

Input Field	Entered
SERIAL NUMBER	88128532
LAW OFFICE ASSIGNED	LAW OFFICE 110
MARK SECTION
MARK	SKINLIFT (standard characters, see http://tmng-al.uspto.gov /resting2/api/img/8812853 2/large)
CORRESPONDENCE SECTION(current)
NAME	AZADEH SHIRAZI, MD
PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE	derm.md1@gmail.com
SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES)	ali360x@gmail.com
ATTORNEY SECTION (proposed)
STATEMENT TEXT	By submission of this request, the undersigned appoints the following new attorney, is newly appearing as the attorney, or updates the information of an existing attorney of record:
NAME	Ali Shalchi
ATTORNEY BAR MEMBERSHIP NUMBER	XXX
YEAR OF ADMISSION	XXXX
U.S. STATE/ COMMONWEALTH/ TERRITORY	XX
FIRM NAME	Shalchi Burch LLP
STREET	23 Corporate Plaza Dr., Suite 150
CITY	Newport Beach
STATE	California
STATE/COUNTRY/REGION/JURISDICTION/U.S. TERRITORY	United States
POSTAL/ZIP CODE	92660
PHONE	9493590334
EMAIL	as@shalchiburchllp.com
CORRESPONDENCE SECTION (proposed)
NAME	Ali Shalchi
PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE	as@shalchiburchllp.com
SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES)	NOT PROVIDED
SIGNATURE SECTION
SIGNATURE	/Ali Shalchi/
SIGNATORY NAME	Ali Shalchi
SIGNATORY DATE	09/14/2020
SIGNATORY POSITION	Attorney of record
SIGNATORY PHONE NUMBER	9493590334
AUTHORIZED SIGNATORY	YES
FILING INFORMATION SECTION
SUBMIT DATE	Mon Sep 14 19:10:01 ET 2020
TEAS STAMP	USPTO/CAR-XXX.XX.XXX.XXX- 20200914191001013297-8826 8537-75090428d7f2f9396b9e 5b6cbbdb21ec6ee9282b708c9 35b50695418ab090ac46-N/A- N/A-20200914185008758488

Under the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number.
PTO Form 2300 (Rev 02/2020)

OMB No. 0651-0051 (Exp 11/30/2020)

Change Address or Representation Form

To the Commissioner for Trademarks:

MARK: SKINLIFT (standard characters, see http://tmng-al.uspto.gov /resting2/api/img/8812853 2/large)
SERIAL NUMBER: 88128532

Correspondence Section (Current):
AZADEH SHIRAZI, MD
PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE: derm.md1@gmail.com
SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES): ali360x@gmail.com

By submission of this request, the undersigned appoints the following new attorney, is newly appearing as the attorney, or updates the information of an existing attorney of record:

Attorney Section (proposed):
Ali Shalchi of Shalchi Burch LLP
XX bar, admitted in XXXX, bar membership no. XXX, is located at
23 Corporate Plaza Dr., Suite 150
Newport Beach, California 92660
United States
9493590334
as@shalchiburchllp.com
Ali Shalchi submitted the following statement: The attorney of record is an active member in good standing of the bar of the highest court of a U.S. state, the District of Columbia, or any U.S. Commonwealth or territory.
Correspondence Section (proposed):
Ali Shalchi
PRIMARY EMAIL ADDRESS FOR CORRESPONDENCE: as@shalchiburchllp.com
SECONDARY EMAIL ADDRESS(ES) (COURTESY COPIES): NOT PROVIDED

Signature: /Ali Shalchi/ Date: 09/14/2020
Signatory's Name: Ali Shalchi
Signatory's Position: Attorney of record
Signatory's Phone Number: 9493590334

Serial Number: 88128532
Internet Transmission Date: Mon Sep 14 19:10:01 ET 2020
TEAS Stamp: USPTO/CAR-XXX.XX.XXX.XXX-202009141910010
13297-88268537-75090428d7f2f9396b9e5b6cb
bdb21ec6ee9282b708c935b50695418ab090ac46
-N/A-N/A-20200914185008758488

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