PTO/AIA/63 Terminal Disclaimer to Accompany Petition Under 37 CFR 1

PTO/AIA/63 (07-16)
Approved for use through XX/XX/XXXX. OMB 0651-0031
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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TERMINAL DISCLAIMER TO ACCOMPANY PETITION
UNDER 37 CFR 1.137 IN A DESIGN APPLICATION
FILED ON OR AFTER SEPTEMBER 16, 2012

Docket Number (Optional)

Applicant:
First named inventor:
Application No.:
Filed:
For:

The applicant, _____________________________________________, owner of __________ percent interest in the instant design
application, hereby disclaims a terminal part of the statutory term of any patent granted on the instant design application equivalent to the
period of abandonment of the instant design application. This disclaimer also applies to any patent granted on a continuing design
application that contains a specific reference under 35 U.S.C. 120, 121, 365(c), or 386(c) to the instant design application. This disclaimer
is binding upon the grantee, and its successors or assigns.

Check either box 1 or 2 below, if appropriate.
I hereby acknowledge that any willful false statements made are punishable under 18 U.S.C. 1001 by fine or imprisonment of not more
than five (5) years, or both.
1.

The undersigned is the applicant. If the applicant is an assignee, the undersigned is authorized to act on behalf of the assignee.

2.

The undersigned is an attorney or agent of record. Reg. No. _______________

__________________________________________________________
Signature

__________________________________
Date

__________________________________________________________
Typed or printed name

__________________________________
Telephone number

_______________________________________________________________________________________________
Title
The terminal disclaimer fee under 37 CFR 1.20(d) is included.
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The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with your
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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
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Additional Uses
Additional USPTO uses of the information in this record may include disclosure to: 1) the International Bureau of the
World Intellectual Property Organization, if the record is related to an international application filed under the Patent
Cooperation Treaty; 2) the public i) after publication of the application pursuant to 35 U.S.C. 122(b), ii) after issuance
of a patent pursuant to 35 U.S.C. 151, iii) if the record was filed in an application which became abandoned or in which
the proceedings were terminated and which application is referenced by either a published application, an application
open to public inspections, or an issued patent, or iv) without publication of the application or patent under the specific
circumstances provided for by 37 CFR 1.14(a)(1)(v)-(vii); and/or 3) the National Archives and Records Administration,
for inspection of records.