PTO/AIA/50 Reissue Patent Application Transmittal

PTO/AIA/50 (03‐13) 
Approved for use through 08/31/2013. OMB 0651‐0033 
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 

REISSUE PATENT APPLICATION TRANSMITTAL 
Address to: 

Attorney Docket No. 

         Mail Stop Reissue 
         Commissioner for Patents 
         P.O. Box 1450 
         Alexandria, VA  22313‐1450 

First Named Inventor 

Original Patent Number 

Original Patent Issue Date
(Month/Day/Year) 

Express Mail Label No. 

APPLICATION FOR REISSUE OF: 
          (Check applicable box)                                                            Utility Patent                                   Design Patent                                    Plant Patent 

APPLICATION ELEMENTS (37 CFR 1.173)

ACCOMPANYING APPLICATION PARTS 

1.          Fee Transmittal Form (PTO/SB/56) 
2.          Applicant asserts small entity status. See 37 CFR 1.27 
3.          Applicant certifies micro entity status. See 37 CFR 1.29. 
             Applicant must attach form PTO/SB/15A or B or equivalent. 
4.          Specification and Claims in double column copy of patent format 
             (amended, if appropriate) 
5.          Drawing(s) (proposed amendments, if appropriate) 
6.          Reissue Oath/Declaration or Substitute Statement 
             (37 CFR 1.175) (PTO/AIA/05, 06, or 07) 
7.          Application Data Sheet     NOTE:  Benefit claims under 37 CFR 1.78 
               and foreign priority claims under 37 CFR 1.55 MUST be set forth in an 
               Application Data Sheet (ADS). 

8.          Original U.S. Patent currently assigned?          Yes          No 

11.          Statement of status and support for all changes to the 
                claims. See 37 CFR 1.173(c). 
12.          Power of Attorney 
13.          Information Disclosure Statement (IDS) 
               PTOSB/08 or PTO‐1449 
                           Copies of citations attached 

14.          English translation of Reissue Oath/Declaration 
                (if applicable) 
16.          Return Receipt Postcard (MPEP § 503) 
                (Should be specifically itemized) 
17.          Other: ____________________________________________ 
                __________________________________________________ 

               (If Yes, check applicable box(es)) 

                __________________________________________________ 

                    Written Consent of all Assigness (PTO/AIA/53) 

                __________________________________________________ 

                    37 CFR 3.73(c) Statement (PTO/AIA/96) 

                __________________________________________________ 

9.          CD‐ROM or CD‐R in duplicate, Computer Program (Appendix) or large
                table 

                __________________________________________________ 

                    Landscape Table on CD 
10.  Nucleotide and/or Amino Acid Sequence Submission 
       (if applicable, items a. – c. are required) 

                __________________________________________________ 

                This is a continuation reissue or divisional reissue application 
                (i.e., a second or subsequent reissue application for the same 
issued patent). (Check box if applicable.) 

      a.          Computer Readable Form (CRF) 
      b.          Specification Sequence Listing on: 
             i.          CD‐ROM (2 copies) or CD‐R (2 copies); or 
             ii.         Paper 
      c.          Statements verifying identity of above copies 

18.  CORRESPONDENCE ADDRESS 

          The address associated with Customer Number: __________________________________        OR             Correspondence address below 
Name 

Address 

City 

Country 

Email 

Signature 

Name (Print/Type) 

State

Zip Code 

Telephone

Date

Registration No.

This collection of information is required by 37 CFR 1.173. 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 12 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: Mail Stop Reissue, 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. 

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 disclosure of these
records is required by the Freedom of Information Act.
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 individuals.
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 inspection 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.