Form PTO/SB/110 Declaration and Power of Attorney for Patent Application

PTO/SB/110
Approved
U.S.
Under

the

Paperwork

Reduction

Act of 1995.

no persons

are required

to respond

Patent

to a collection

and

Trademark

of information

for use through
Office;
unless

U.S.

10/31/2002.

DEPARTMENT

it displays

a valid

(05-95)

OMB

0651-0032

OF COMMERCE
OMB

control

number

Declaration and Power of Attorney for Patent Application

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As a beio'N named Inventor .I hereby declare that:

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My residence,

post offICe address

and citizenship

are as stated

next to my name.

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I believe I am the original, first and sole inventor (if only one
name is listed below) or an original, first and joint inventor (If
plural names are listed below) of the subject matter whIch Is
claimed and for whIch a patent Is sought on the Invention
entitled

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the specifICation of whIch
following box Is checked:

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was filed on
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Application

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Number

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