PTO/AIA/11 Substitute Statement Supplemental Sheet

PTO/AIA/11 (06-12)
Approved for use through 01/31/2014. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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SUBSTITUTE
STATEMENT SUPPLEMENTAL SHEET

INVENTOR(S)

Supplemental Sheet (for PTO/AIA/02,04,07)
Page _

of

Note: List entire inventive entity in the desired order.
Legal Name of Joint Inventor:
(E.g., Given Name (first and middle (if any)) and Family Name or Surname)

Inventor’s
Signature

Date (Optional)

Residence: City

State

Country

Mailing Address
City

State

Zip

Country

Legal Name of Joint Inventor:
(E.g., Given Name (first and middle (if any)) and Family Name or Surname)

Inventor’s
Signature

Date (Optional)

Residence: City

State

Country

Mailing Address
City

State

Zip

Country

Legal Name of Joint Inventor:
(E.g., Given Name (first and middle (if any)) and Family Name or Surname)

Inventor’s
Signature
Residence: City

Date (Optional)
State

Country

Mailing Address

City

State

Zip

Country

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  Privacy Act of 1974 (P.L. 93-579)
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The
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