PTO/SB/02JP Declaration (Additional Inventors) and Supplemental Prio

PTO/SB/02A (07-07)
XXXX 年 1 月 31 日までまで使用許可。OMB 0651-0032
米国特許商標局;米国商務省
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
1995 年の文書業務削減法により、有効な OMB 管理番号の記載がない限り、情報収集に応じることを要求されない。
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.

追加発明者
ADDITIONAL INVENTOR(S)

宣言書
DECLARATION

補足用紙
Supplemental Sheet

ページの
Page

ページ目
of

当該非署名発明者について請願書をすでに申請している
A petition has been filed for this unsigned inventor

共同発明者氏名:
Name of Additional Joint Inventor, if any:
名（ファーストおよびミドルネーム）
Given Name (first and middle (if any))

姓
Family Name or Surname

発明者署名
Inventor’s Signature

日付
Date

居住地: 都市
Residence: City

州
State

国
Country

国籍
Citizenship

郵送先住所
Mailing Address
都市
City

州
State

郵便番号
Zip

国
Country

当該非署名発明者について請願書をすでに申請している
A petition has been filed for this unsigned inventor

共同発明者氏名:
Name of Additional Joint Inventor, if any:
名（ファーストおよびミドルネーム）
Given Name (first and middle (if any))

姓
Family Name or Surname

発明者署名
Inventor’s Signature

日付
Date

居住地: 都市
Residence: City

州
State

国
Country

国籍
Citizenship

郵送先住所
Mailing Address
都市
City

州
State

郵便番号
Zip

当該非署名発明者について請願書をすでに申請している
A petition has been filed for this unsigned inventor

共同発明者氏名:
Name of Additional Joint Inventor, if any:
名（ファーストとミドルネーム）
Given Name (first and middle (if any))

姓
Family Name or Surname

発明者署名
Inventor’s Signature
居住地: 都市
Residence: City

国
Country

日付
Date
州
State

国
Country

国籍
Citizenship

郵送先住所
Mailing Address
都市
City

州
State

郵便番号
Zip

国
Country

当該情報収集は 35 U.S.C. 115 および 37 CFR 1.63 によって要請されている。 本情報は、出願申請する一般民衆（および処理する米国特許商標局）の便益を取得または保持するために必要な
ものである。機密保持は、35 U.S.C. 122、そして 37 CFR 1.11 と 1.14 によって律則されている。 当該収集は、本申請用紙の入手と記入、さらに記入の済んだ本申請用紙の米国特許商標局へ
の提出を含み、完了までに 21 分間を要するものと推定される。要する時間は個々の事例により異なる。本用紙の記入完了に要する時間についての意見、および当該義務の軽減についての
提案は、22313‐1450 バージニア州アレキサンドリア市私書箱 1450 号米国商務省米国特許商標局主席情報官宛てに送付のこと。本住所宛に手数料や記入済み用紙を送付してはならない。
送付先: 22313‐1450 バージニア州アレキサンドリア市私書箱 1450 号特許長官宛。
This collection of information is required by 35 U.S.C. 115 and 37 CFR 1 .63. The info rmation is re quired to obtain o r reta in a benefit b y the pu blic which is to file (an d by th e US PTO 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 Administrative 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.

本用紙の記入についてお手伝いが必要な場合は、1-800-PTO-9199（1-800-786-9199）に電話してオプション２を選択してください。
If you need assistance in completing the form, call 1-800-PTO-9199 (1-800-786-9199) and select option 2.

PTO/SB/02B (07-07)
XXXX 年 1 月 31 日までまで使用許可。OMB 0651-0032
米国特許商標局; 米国商務省
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
1995 年の文書業務削減法により、有効な OMB 管理番号の記載がない限り、情報収集に応じることを要求されない。
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.

宣言書 – 優先データ補足用紙

DECLARATION – Supplemental Priority Data Sheet
国外出願:
Foreign applications:
先行海外出願番号
Prior Foreign Application Number(s)

国
Country

海外出願日
Foreign Filing Date
（月/日/西暦年）
(MM/DD/YYYY)

優先権を主張しない
Priority Not Claimed

認証複写の添付
Certified Copy Attached?
有
無
YES NO

当該情報収集は 35 U.S.C. 115 および 37 CFR 1.63 によって要請されている。 本情報は、出願申請する一般民衆（および処理する米国特許商標局）の便益を取得または保持するために必要な
ものである。機密保持は、35 U.S.C. 122、そして 37 CFR 1.11 と 1.14 によって律則されている。 当該収集は、本申請用紙の入手と記入、さらに記入の済んだ本申請用紙の米国特許商標局へ
の提出を含み、完了までに 21 分間を要するものと推定される。要する時間は個々の事例により異なる。本用紙の記入完了に要する時間についての意見、および当該義務の軽減についての
提案は、22313‐1450 バージニア州アレキサンドリア市私書箱 1450 号米国商務省米国特許商標局主席情報官宛てに送付のこと。本住所宛に手数料や記入済み用紙を送付してはならない。
送付先: 22313‐1450 バージニア州アレキサンドリア市私書箱 1450 号特許長官宛。
This collection of information is required by 35 U.S.C. 115 and 37 CFR 1 .63. The info rmation is re quired to obtain o r reta in a benefit b y the pu blic which is to file (an d by th e US PTO 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 Administrative 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.

本用紙の記入についてお手伝いが必要な場合は、1-800-PTO-9199（1-800-786-9199）に電話してオプション２を選択してください。
If you need assistance in completing the form, call 1-800-PTO-9199 (1-800-786-9199) and select option 2.

OMB Clearance and PRA Burden Statement for PTO/SB/02B
This collection of information is required by 37 CFR 1.137. 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, 1.14 and 41.6. This form is estimated to
take 21 minutes to complete, including gathering, preparing, and submitting the completed 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 Administration 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 Petition, Commissioner for Patents, P.O. Box 1450, Alexandria, VA
22313-1450.

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. The United States Patent and Trademark Office (USPTO) collects this information under authority of 5 CFR 339.205.
The information in this system of records is used to manage all records of applicant including name, citizenship, residence, post office address and
other information pertaining to the applicant's activities in connection with the invention for which a patent is sought. Statements containing various
kinds of information with respect to inventors who are deceased or incapacitated, or who are unavailable or unwilling to make application for patent.
The information obtain is protected from disclosure to third parties in accordance with the Privacy Act.
However, routine uses of this information may include disclosure to the following: to law enforcement and investigation in the event that the system
of records indicates a violation or potential violation of law; to a Federal, state, local, or international agency, in response to its request; to an agency,
organization, or individual for the purpose of performing audit or oversight operations as authorized by law; to non-federal personnel under contract
to the agency; to a court for adjudication and litigation; to the Department of Justice for Freedom of Information Act (FOIA) assistance; to members of
congress working on behalf of an individual; to the Office of Personnel Management (OPM) for personnel research purposes; to National Archives and
Records Administration for inspection of records; and to the Office of Management and Budget (OMB)for legislative coordination and clearance.
Failure to provide any part of the requested information may result in an inability to process requests for access and information. The applicable
Privacy Act System of Records Notice for this information is COMMERCE/PAT-TM-7 Patent Application Files, available at Federal Register /Vol. 78, No.
61 / Friday, March 29, 2013 /Notices 19243. https://www.govinfo.gov/content/pkg/FR-2013-03-29/pdf/2013-07341.pdf