Form PTO/SB/130 EFS-Web PTO/SB/130 EFS-Web Petition to Make Special Based on Age for Advancement of

Doc code : PET.OP.AGE
Description : Petition to make special based on Age/Health

PTO/SB/130 (06-09)
Approved for use through 06/30/2009. OMB 0651- 0031
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number

PETITION TO MAKE SPECIAL BASED ON AGE FOR ADVANCEMENT OF EXAMINATION
UNDER 37 CFR 1.102(c)(1)
Application Information
Application
Number

Confirmation
Number

Filing
Date

Attorney Docket
Number (optional)

Art Unit

Examiner

First Named
Inventor
Title of Invention
Attention: Office of Petitions
An application may be made special for advancement of examination upon filing of a petition showing that the applicant is 65
years of age, or more. No fee is required with such a petition. See 37 CFR 1.102(c)(1) and MPEP 708.02 (IV).
APPLICANT HEREBY PETITIONS TO MAKE SPECIAL FOR ADVANCEMENT OF EXAMINATION IN THIS APPLICATION
UNDER 37 CFR 1.102(c)(1) and MPEP 708.02 (IV) ON THE BASIS OF THE APPLICANT'S AGE.
A grantable petition requires one of the following items:
(1) Statement by one named inventor in the application that he/she is 65 years of age, or more; or
(2) Certification by a registered attorney/agent having evidence such as a birth certificate, passport, driver's license, etc.
showing one named inventor in the application is 65 years of age, or more.
Name of Inventor who is 65 years of age, or older
Given Name

Middle Name

Family Name

Suffix

A signature of the applicant or representative is required in accordance with 37 CFR 1.33 and 10.18.
Please see 37 CFR 1.4(d) for the format of the signature.
Select (1) or (2) :
(1) I am an inventor in this application and I am 65 years of age, or more.
(2) I am an attorney or agent registered to practice before the Patent and Trademark Office, and I certify that I am in possession of
evidence, and will retain such in the application file record, showing that the inventor listed above is 65 years of age, or more.

Signature

Date
(YYYY-MM-DD)

Name

Registration
Number

EFSWeb 1.0.16

Doc code : PET.OP.AGE
Description : Petition to make special based on Age/Health

PTO/SB/130 (06-09)
Approved for use through 06/30/2009. OMB 0651- 0031
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number

Privacy Act Statement

The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with your submission of
the attached form related to a patent application or patent. Accordingly, pursuant to the requirements of the Act, please be
advised that: (1) the general authority for the collection of this information is 35 U.S.C. 2(b)(2); (2) furnishing of the
information solicited is voluntary; and (3) the principal purpose for which the information is used by the U.S. Patent and
Trademark Office is to process and/or examine your submission related to a patent application or patent. If you do not
furnish the requested information, the U.S. Patent and Trademark Office may not be able to process and/or examine your
submission, which may result in termination of proceedings or abandonment of the application or expiration of the patent.
The information provided by you in this form will be subject to the following routine uses:
1.

The information on this form will be treated confidentially to the extent allowed under the Freedom of Information
Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C. 552a). Records from this system of records may be disclosed to the
Department of Justice to determine whether the Fr eedom of Information Act requires disclosure of these records.

2.

A record from this system of records may be disclosed, as a routine use, in the course of presenting evidence to
a court, magistrate, or administrative tribunal, including disclosures to opposing counsel in the course of settlement
negotiations.

3.

A record in this system of records may be disclosed, as a routine use, to a Member of Congress submitting a
request involving an individual, to whom the record pertains, when the individual has requested assistance from the
Member with respect to the subject matter of the record.

4.

A record in this system of records may be disclosed, as a routine use, to a contractor of the Agency having need
for the information in order to perform a contract. Recipients of information shall be required to comply with the
requirements of the Privacy Act of 1974, as amended, pursuant to 5 U.S.C. 552a(m).

5.

A record related to an International Application filed under the Patent Cooperation Treaty in this system of
records may be disclosed, as a routine use, to the International Bureau of the World Intellectual Property
Organization, pursuant to the Patent Cooperation Treaty.

6.

A record in this system of records may be disclosed, as a routine use, to another federal agency for purposes of
National Security review (35 U.S.C. 181) and for review pursuant to the Atomic Energy Act (42 U.S.C. 218(c)).

7.

A record from this system of records may be disclosed, as a routine use, to the Administrator, General Services,
or his/her designee, during an inspection of records conducted by GSA as part of that agency's responsibility to
recommend improvements in records management practices and programs, under authority of 44 U.S.C. 2904 and
2906. Such disclosure shall be made in accordance with the GSA regulations governing inspection of records for this
purpose, and any other relevant (i.e., GSA or Commerce) directive. Such disclosure shall not be used to make
determinations about indivi duals.

8.

A record from this system of records may be disclosed, as a routine use, to the public after either publication of
the application pursuant to 35 U.S.C. 122(b) or issuance of a patent pursuant to 35 U.S.C. 151. Further, a record
may be disclosed, subject to the limitations of 37 CFR 1.14, as a routine use, to the public if the record was filed in an
application which became abandoned or in which the proceedings were terminated and which application is
referenced by either a published application, an application open to public inspections or an issued patent.

9.

A record from this system of records may be disclosed, as a routine use, to a Federal, State, or local law
enforcement agency, if the USPTO becomes aware of a violation or potential violation of law or regulation.

EFSWeb 1.0.16