Form PTO/SB/01 Declaration for Utility or Design Patent Application (37

Doc Code: Oath
Document Description: Oath or declaration filed

PTO/SB/01 (09-12)
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 contains a valid OMB control number.

DECLARATION FOR UTILITY OR
DESIGN
PATENT APPLICATION
(37 CFR 1.63)
Declaration
Submitted
With Initial
Filing

OR

Declaration
Submitted After Initial
Filing (surcharge
(37 CFR 1.16(f))
required)

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

I hereby declare that: (1) Each inventor's residence, mailing address, and citizenship are as stated below next to their name;
and (2) I believe the inventor(s) named below to be the original and first inventor(s) of the subject matter which is claimed and
for which a patent is sought on the invention titled:

(Title of the Invention)
the application of which was made or was authorized to be made by me and
is attached hereto
OR
was filed on (MM/DD/YYYY)
Application Number

as United States Application Number or PCT International
and was amended on (MM/DD/YYYY)

(if applicable).

I hereby state that I have reviewed and understand the contents of the above identified application, including the claims, as
amended by any amendment specifically referred to above.
I acknowledge the duty to disclose information which is material to patentability as defined in 37 CFR 1.56, including for
continuation-in-part applications, material information which became available between the filing date of the prior application
and the national or PCT international filing date of the continuation-in-part application.

Authorization To Permit Access To Application by Participating Offices
If checked, the undersigned hereby grants the USPTO authority to provide the European Patent Office (EPO), the
Japan Patent Office (JPO), the Korean Intellectual Property Office (KIPO), the World Intellectual Property Office (WIPO), and
any other intellectual property offices in which a foreign application claiming priority to the above-identified patent application is
filed access to the above-identified patent application. See 37 CFR 1.14(c) and (h). This box should not be checked if the
applicant does not wish the EPO, JPO, KIPO, WIPO, or other intellectual property office in which a foreign application claiming
priority to the above-identified patent application is filed to have access to the above-identified patent application.
In accordance with 37 CFR 1.14(h)(3), access will be provided to a copy of the above-identified patent application with respect
to: 1) the above-identified patent application-as-filed; 2) any foreign application to which the above-identified patent application
claims priority under 35 U.S.C. 119(a)-(d) if a copy of the foreign application that satisfies the certified copy requirement of
37 CFR 1.55 has been filed in the above-identified patent application; and 3) any U.S. application-as-filed from which benefit is
sought in the above-identified patent application.
In accordance with 37 CFR 1.14(c), access may be provided to information concerning the date of filing the Authorization to
Permit Access to Application by Participating Offices.
[Page 1 of 3]
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/01 (09-12)
Approved for use through 0113112014. 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 contains a valid OMB control number.

DECLARATION — Utility or Design Patent Application

Claim of Foreign Priority Benefits
I hereby claim foreign priority benefits under 35 U.S.C. 119(a)-(d) or (f ), or 365(b) of any foreign application(s) for patent,
inventor's or plant breeder's rights certificate(s), or 365(a) of any PCT international application which designated at least one
country other than the United States of America, listed below and have also identified below, by checking the box, any foreign
application for patent, inventor's or plant breeder's rights certificate(s), or any PCT international application having a filing date
before that of the application on which priority is claimed.

Prior Foreign Application
Number(s)

Country

Foreign Filing Date
(MM/DD/YYYY)

Priority
Not Claimed

Certified Copy Attached?
YES
NO

Additional foreign application number(s) are listed on a supplemental priority data sheet PTO/SB/02B attached hereto.

[Page 2 of 3]

PTO/SB/01 (09-12)
Approved for use through 0113112014. 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 contains a valid OMB control number.

DECLARATION — Utility or Design Patent Application

Direct all
correspondence to:

The address
associated with
Customer Number:

Correspondence
address below

OR

Name

Address

State

City

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.
I hereby declare that all statements made herein of my own knowledge are true and that all statements made on information and
belief are believed to be true; and further that these statements were made with the knowledge that willful false statements and
the like so made are punishable by fine or imprisonment, or both, under 18 U.S.C. 1001 and that such willful false statements
may jeopardize the validity of the application or any patent issued thereon.
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.
NAME OF SOLE OR FIRST INVENTOR:
Given Name (first and middle [if any])

A petition has been filed for this unsigned inventor
Family Name or Surname

Date

Inventor's Signature

Residence: City

State

Country

Citizenship

State

Zip

Country

Mailing Address

City

Additional inventors or a legal representative are being named on the

[Page 3 of 3]

supplemental sheet(s) PTO/SB/02A or 02LR attached hereto

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.