PTO/AIA/02 Substitute Statement In Lieu of an Oath or Declaration f

Doc code: Oath
Document Description: Oath or declaration filed

PTO/$,$ (06-15)
Approved for use through 05/31/2024. 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.

SUBSTITUTE STATEMENT IN LIEU OF AN OATH OR DECLARATION FOR UTILITY
OR DESIGN PATENT APPLICATION (35 U.S.C. 115(d) AND 37 CFR 1.64)
Title of
Invention

This statement is directed to:
The attached application,

OR
United States application or PCT international application number ____________________ filed on ___________________.

LEGAL NAME of inventor to whom this substitute statement applies:
(E.g., Given Name (first and middle (if any)) and Family Name or Surname)

Residence (except for a deceased or legally incapacitated inventor):
City

State

Country

Mailing Address (except for a deceased or legally incapacitated inventor):

City

Zip

State

Country

I believe the above-named inventor or joint inventor to be the original inventor or an original joint inventor of a claimed invention
in the application.
The above-identified application was made or authorized to be made by me.
I hereby acknowledge that any willful false statement made in this statement is punishable under 18 U.S.C. 1001 by fine or
imprisonment of not more than five (5) years, or both.

Relationship to the inventor to whom this substitute statement applies:
Legal Representative (for deceased or legally incapacitated inventor only),
Assignee,
Person to whom the inventor is under an obligation to assign,
Person who otherwise shows a sufficient proprietary interest in the matter (petition under 37 CFR 1.46 is required), or
Joint Inventor.
[Page 1 of 2]
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If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

PTO/SB/$,$ (06-15)
Approved for use through 05/31/2024. 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.

SUBSTITUTE STATEMENT
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Inventor is deceased,
Inventor is under legal incapacity,
Inventor cannot be found or reached after diligent effort, or
Inventor has refused to execute the oath or declaration under 37 CFR 1.63.
If there are joint inventors, please check the appropriate box below:
An application data sheet under 37 CFR 1.76 (PTO/$,$/14 or equivalent) naming the entire inventive entity has been
or is currently submitted.

OR
An application data sheet under 37 CFR 1.76 (PTO/$,$/14 or equivalent) has not been submitted. Thus, a Substitute
Statement Supplemental Sheet (PTO/$,$ or equivalent) naming the entire inventive entity and providing inventor
information is attached. See 37 CFR 1.64(b).

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.
PERSON EXECUTING THIS SUBSTITUTE STATEMENT:
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Signature:
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Country
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>Page 2 of 2]

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 the information in this record under authority of 35
U.S.C. 2. The USPTO’s system of records is used to manage all applicant and owner information
including name, citizenship, residence, post office address, and other information with respect to
inventors and their legal representatives pertaining to the applicant's/owner’s activities in connection
with the invention for which a patent is sought or has been granted. The applicable Privacy Act System
of Records Notice for the information collected in this form is COMMERCE/PAT-TM-7 Patent
Application Files, available in the Federal Register at 78 FR 19243 (March 29, 2013). https://
www.govinfo.gov/content/pkg/FR-2013-03-29/pdf/2013-07341.pdf
Routine uses of the information in this record may include disclosure to: 1) law enforcement, in the
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(i.e., GSA or Commerce) directive, where such disclosure shall not be used to make determinations
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If you do not furnish the information requested on this form, the USPTO may not be able to process
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Additional Uses
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