PTO/SB/105 Declaration for Utility or Design Patent Application - F

PTO/SB/105 (2-98)
Approved for use through X/XX/XX. OMB 0032
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 and Power of Attorney for Patent Application
Déclaration et Pouvoirs pour Demande de Brevet
French Language Declaration

En tant que l'inventeur nommé ci-après, je déclare par le présent
acte que:

As a below named inventor, I hereby declare that:

Mon domicile, mon adresse postale et ma nationalité sont ceux
figurant ci-dessous à côté de mon nom.

My residence, post office address and citizenship are as stated
next to my name.

Je crois être le premier inventeur original et unique (si un seul
nom est mentionné ci-dessous), ou l'un des premiers coinventeurs originaux (si plusieurs noms sont mentionnés cidessous) de l'objet revendiqué, pour lequel une demande de
brevet a été déposée concernant l'invention intitulée

I believe I am the original, first and sole inventor (if only one
name is listed below) or an original, first and joint inventor (if
plural names are listed below) of the subject matter which is
claimed and for which a patent is sought on the invention entitled

et dont la description est fournie ci-joint à moins que la case
suivante n'ait été cochée:

the specification of which is attached hereto unless the following
box is checked:

~

~

a été déposée le
sous le numéro de demande des Etats-Unis ou le
numéro de demande international PCT
et modifiée le
(le cas échéant).

Je déclare par le présent acte avoir passé en revue et compris le
contenu de la description ci-dessus, revendications comprises,
telles que modifiées par toute modification dont il aura été fait
référence ci-dessus.

Je reconnais devoir divulguer toute information pertinente à la
brevetabilité, comme défini dans le Titre 37, § 1.56 du Code
fédéral des réglementations.

was filed on
as United States Application Number or PCT
International Application Number
and was amended on
(if applicable).

I hereby state that I have reviewed and understand the contents
of the above identified specification, including the claims, as
amended by any amendment referred to above.

I acknowledge the duty to disclose information which is material
to patentability as defined in Title 37, Code of Federal
Regulations, § 1.56.

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DC 20231. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Assistant Commissioner for Patents, Washington, DC
20231.

PTO/SB/105 (2-98)
Approved for use through X/XX/XX. OMB 0032
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.

French Language Declaration
Je revendique par le présent acte avoir la priorité étrangère, en
vertu du Titre 35, § 119(a)-(d) ou § 365(b) du Code des EtatsUnis, sur toute demande étrangère de brevet ou certificat
d'inventeur ou, en vertu du Titre 35, § 365(a) du même Code, sur
toute demande internationale PCT désignant au moins un pays
autre que les Etats-Unis et figurant ci-dessous et, en cochant la
case, j'ai aussi indiqué ci-dessous toute demande étrangère de
brevet, tout certificat d'inventeur ou toute demande internationale
PCT ayant une date de dépôt précédant celle de la demande à
propos de laquelle une priorité est revendiquée.

I hereby claim foreign priority under Title 35, United States
Code, § 119(a)-(d) or § 365 (b) of any foreign application(s) for
patent or inventor's certificate, or § 365(a) of any PCT
International application which designated at least one country
other than the United States, listed below, and have also
identified below, by checking the box, any foreign application for
patent or inventor's certificate, or PCT International application
having a filing date before that of the application on which
priority is claimed.

Prior foreign application(s)
Demande(s) de brevet antérieure(s)
(Number)
(Numéro)

(Country)
(Pays)

(Number)
(Numéro)

(Country)
(Pays)

Priority Claimed
Droit de priorité revendiqué
(Day/Month/Year Filed)
(Jour/Mois/Année de dépôt)
(Day/Month/Year Filed)
(Jour/Mois/Année de dépôt)

Je revendique par le présent acte tout bénéfice, en vertu du Titre
35, § 119(e) du Code des Etats-Unis, de toute demande de brevet
provisoire effectuée aux Etats-Unis et figurant ci-dessous.
(Application No.)
(N0 de demande)

(Filing Date)
(Date de dépôt)

(Application No.)
(N0 de demande)

(Filing Date)
(Date de dépôt)

Je revendique par le présent acte tout bénéfice, en vertu du Titre
35, § 120 du Code des Etats-Unis, de toute demande de brevet
effectuée aux Etats-Unis, ou en vertu du Titre 35, § 365(c) du
même Code, de toute demande internationale PCT désignant les
Etats-Unis et figurant ci-dessous et, dans la mesure où l'objet de
chacune des revendications de cette demande de brevet n'est pas
divulgué dans la demande antérieure américaine ou internationale
PCT, en vertu des dispositions du premier paragraphe du Titre
35, § 112 du Code des Etats-Unis, je reconnais devoir divulguer
toute information pertinente à la brevetabilité, comme défini dans
le Titre 37, § 1.56 du Code fédéral des réglementations, dont j'ai
pu disposer entre la date de dépôt de la demande antérieure et la
date de dépôt de la demande nationale ou internationale PCT de
la présente demande:
(Application No.)
(N0 de demande)

(Filing Date)
(Date de dépôt)

(Application No.)
(N0 de demande)

(Filing Date)
(Date de dépôt)

~
~

I hereby claim the benefit under Title 35, United States Code, §
119(e) of any United States provisional application(s) listed
below.

I hereby claim the benefit under Title 35, United States Code, §
120 of any United States application(s), or § 365(c) of any PCT
International application designating the United States, listed
below and, insofar as the subject matter of each of the claims of
this application is not disclosed in the prior United States or PCT
International application in the manner provided by the first
paragraph of Title 35, United States Code, § 112, I acknowledge
the duty to disclose information which is material to patentability
as defined in Title 37, Code of Federal Regulations, § 1.56 which
became available between the filing date of the prior application
and the national or PCT International filing date of this
application.

(Status) (patented, pending, abandoned)
(Statut) (breveté, en cours d'examen, abandonné)
(Status) (patented, pending, abandoned)
(Statut) (breveté, en cours d'examen, abandonné)

Je déclare par le présent acte que toute déclaration ci-incluse est,
à ma connaissance, véridique et que toute déclaration formulée
à partir de renseignements ou de suppositions est tenue pour
véridique; et de plus, que toutes ces déclarations ont été
formulées en sachant que toute fausse déclaration volontaire ou
son équivalent est passible d'une amende ou d'une incarcération,
ou des deux, en vertu de la Section 1001 du Titre 18 du Code des
Etats-Unis, et que de telles déclarations volontairement fausses
risquent de compromettre la validité de la demande de brevet ou
du brevet délivré à partir de celle-ci.

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 Section 1001 of Title 18 of the
United States Code and that such willful false statements may
jeopardize the validity of the application or any patent issued
thereon.

[Page 2 of 3]

PTO/SB/105 (2-98)
Approved for use through X/XX/XX. OMB 0032
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.

French Language Declaration
POUVOIRS: En tant que l'inventeur cité, je désigne par la
présente l'(les) avocat(s) et/ou agent(s) suivant(s) pour qu'ils
poursuive(nt) la procédure de cette demande de brevet et
traite(nt) toute affaire s'y rapportant avec l'Office des brevets et
des marques:
(mentionner le nom et le numéro
d'enregistrement).

POWER OF ATTORNEY: As a named inventor, I hereby
appoint the following attorney(s) and/or agent(s) to prosecute this
application and transact all business in the Patent and Trademark
Office connected therewith: (list name and registration number)

Adresser toute correspondance à:

Send Correspondence to:

Adresser tout appel téléphonique à:
(nom et numéro de téléphone)

Direct Telephone Calls to:
(name and telephone number)

Nom complet de l'unique ou premier inventeur

Full name of sole or first inventor

Signature de l'inventeur

Inventor's signature

Date

Date

Domicile

Residence

Nationalité

Citizenship

Adresse postale

Post Office Address

Nom complet du second co-inventeur, le cas échéant

Full name of second joint inventor, if any

Signature du second inventeur

Second Inventor's signature

Date

Domicile

Residence

Nationalité

Citizenship

Adresse postale

Post Office Address

(Fournir les mêmes renseignements et la signature de tout
inventeur supplémentaire.)

co-

Date

(Supply similar information and signature for third and
subsequent joint inventors.)

[Page 3 of 3]

OMB Clearance and PRA Burden Statement for PTO/SB/105
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