Form PTO/SB/AIA09 Plant Patent Application (35 U.S.C. 161) Declaration (37

Initial Patent Applications

PTO_SB_AIA09

Original New Plant Applications - No Application Data Sheet

OMB: 0651-0032

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Doc Code: Oath
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___

PTO/SB/AIA09 (06-12)
Approved for use through 01/31/2014. OMB 0651-0032
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 displays a valid OMB control number.

PLANT PATENT 

APPLICATION (35 U.S.C. 161) 

DECLARATION 

(37 CFR 1.)

Declaration
Submitted
with Initial
Filing

OR

Declaration
Submitted after Initial
Filing (surcharge
(37 CFR 1.16(e))
required)

Attorney Docket Number
First Named Inventor
COMPLETE IF KNOWN
Application Number
Filing Date
Art Unit
Examiner Name

The new and distinct variety of:

plant named:

As a below named inventor, I hereby declare that:
This declaration is directed to:
The attached application
OR

Residence: City
United States Application Number ____________________ filed on (MM/DD/YYYY) ____________________________ .

I have asexually reproduced the plant to which this application applies.

Said plant was found in cultivated area (check this box for newly found plant only)
The above-identified application was made or authorized to be made by me.
I believe I am the original inventor or an original joint inventor of a claimed invention in the application.
I hereby acknowledge that any willful false statement made in this declaration is punishable under 18 U.S.C. 1001
by fine or imprisonment of not more than five (5) years, or both.

[Page 1 of 2]
This collection of information is required by 35 U.S.C. 115 and 37 CFR 1.63. The information is required to obtain or retain a benefit by the public which is to file
(and by the USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 21
minutes to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual
case. Any comments on the amount of time you require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Information
Officer, U.S. Patent and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED
FORMS TO THIS ADDRESS. SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

PTO/SB/AIA09 (06-12)
Approved for use through 01/31/2014. OMB 0651-0032
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 displays a valid OMB control number.

Doc Code:

DECLARATION - Plant Patent Application
Direct all correspondence to:
OR

The address associated with Customer Number:
Correspondence address below

Name
Address

City

State

Country

Zip

Telephone

Email

WARNING:
Petitioner/applicant is cautioned to avoid submitting personal information in documents filed in a patent application that may
contribute to identity theft. Personal information such as social security numbers, bank account numbers, or credit card
numbers (other than a check or credit card authorization form PTO-2038 submitted for payment purposes) is never required by
the USPTO to support a petition or an application. If this type of personal information is included in documents submitted to the
USPTO, petitioners/applicants should consider redacting such personal information from the documents before submitting them
to the USPTO. Petitioner/applicant is advised that the record of a patent application is available to the public after publication of
the application (unless a non-publication request in compliance with 37 CFR 1.213(a) is made in the application) or issuance of
a patent. Furthermore, the record from an abandoned application may also be available to the public if the application is
referenced in a published application or an issued patent (see 37 CFR 1.14). Checks and credit card authorization forms PTO­
2038 submitted for payment purposes are not retained in the application file and therefore are not publicly available.

LEGAL NAME OF SOLE OR FIRST INVENTOR:
((J Given Name (first and middle (if any) and Family Name or Surname)
Inventor's Signature

Date (Optional)
State

Residence: City

Country

Mailing Address

City

State

Zip

Country

Additional inventors are being named on the_____ supplemental sheet(s) PTO/SB/AIA10 attached hereto
[Page 2 of 2]

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;
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not furnish the requested information, the U.S. Patent and Trademark Office may not be able to
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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:
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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
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File TitleMicrosoft Word - sb0003.doc
Authorjclark2
File Modified2012-07-09
File Created2010-05-04

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