Form PTO/SB/03 Plant Patent Application (35 U.S.C. 161) Declaration (37

PTO/SB/03 (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 displays a valid OMB control number.

PLANT PATENT

APPLICATION (35 U.S.C. 161)

DECLARATION

(37 CFR 1.63)

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

I hereby declare that:
Each inventor’s residence, mailing address, and citizenship are as stated below next to their name.
I believe the inventor(s) name below to be the original and first inventor(s) of the new and distinct variety of:

plant named:
which is claimed and for which a plant patent is sought, the application of which
is attached hereto OR

was filed on (MM/DD/YYYY)

Application Number

as United States

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 claim, as
amended by any amendment specifically referred to above; I have asexually reproduced the plant to which this application
applies; and this application was made or authorized to be made by me.
Said plant was found in cultivated area (check this box for newly found plant only)
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.
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)

Check Only If
Priority
Not Claimed

Certified Copy Attached?
YES

NO

Additional foreign application numbers are listed on a supplemental priority data sheet PTO/SB/02B attached hereto.
[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/03 (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 displays a valid OMB control number.

DECLARATION - Plant Patent Application
Direct all correspondence to:
OR

The address associated with Customer Number:
Correspondence address below

Name
Address
Address
City

State

Country

Telephone

ZIP
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 of not more than 5 years, 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

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

Inventor's Signature
Residence: City

Date
State

Country

State

Zip

Citizenship

Mailing Address
Mailing Address
City

Country

Additional inventors or legal representative(s) are being named on the_____ supplemental sheet(s) PTO/SB/02A or 02LR attached hereto.
[Page 2 of 2]

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