PTO/SB/59 Request for Supplemental Examination Transmittal Form

PTO/SB/59 (07-12)
Approved for use through xx/xx/20xx. OMB 0651-0064
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 u nless it displays a valid OMB control number.

REQUEST FOR SU
UPPLEMEN
NTAL EXA
AMINATION
N TRANSM
MITTAL FOR
RM

Addre
ess to:

Comm
missioner for Patents
P.O. Box 1450

Alexa
andria, VA 22313-1450

Attorney Do
ocket No.:
Date:

1.

This is a request for supplemental examination pu
ursuant to 37 C FR 1.610 of pa
atent number _____________
_____
d ___________
____________
___. 37 CFR 1.610(b)(1).
issued

2.

Supple
emental examination of claim
m(s) _________
_____________
____________
____________
_____is requested.
37 CF
FR 1.610(b)(4).

3.

a. The
e name(s) of the
e patent ownerr(s) (not the pa
atent practitione
er(s)) is (are):
_____
_____________
____________
_____________
____________
____________
_____________
____________
___
_____
_____________
____________
_____________
_____________
____________
_____________
____________
___
_____
_____________
____________
_____________
_____________
____________
_____________
____________
___
______
____________
_____________
____________
____________
_____________
____________
_____________
__
b. A submission by the patent owner(s) in complia
ance with 37 C FR 3.73(c), wh
hich establishe
es that the pate
ent
own
ner(s) has (hav
ve) the entirety of the ownersh
hip in the paten
nt for which sup
pplemental exa
amination is
uested, is inclu
uded. 37 CFR 1.610(b)(9).
requ

4.

mount of $____
_________ is enclosed to covver the fee for processing and
d treating a
a. A check in the am
req
quest for supplemental examination, the fee
e for reexamina
ation ordered u
under 35 USC 257, and the fe
ee for
ocessing and treating each no
on-patent docu
ument over 20 sheets in lengtth (37 CFR 1.2
20(k)(1 - 3));
pro
b. The Director is he
ereby authorize
ed to charge all applicable fee
es as set forth in 37 CFR 1.20
0(k)(1 - 3)
to Deposit Account No. _______
____________
_______; or
c. Pay
yment by crediit card. Form PTO-2038 is atttached. 37 CF
FR 1.610(a).

5.

Any refund should be made by
check or
credit to D eposit Accountt No.________
___________.
ade by credit ca
ard, refund must be to the cre
edit card accou
unt.
37 CFR 1.26(c). If payment is ma

6.

A cop
py of the patentt for which supplemental exam
mination is req
quested, and a copy of any dissclaimer or
certifiicate issued forr the patent are
e included. 37 CFR 1.610(b)((6).

7.

CD-R
ROM or CD-R in
n duplicate, Co
omputer Progra
am (Appendix) or large table
Landscape Table on CD

8.

Nucle
eotide and/or Amino Acid Seq
quence Submis
ssion
If app
plicable, items a. – c. are required.
a.
Computer Re
eadable Form (CRF)
b. Specification Seq
quence Listing on:
i.
ii.
c.

9.

CD-RO
OM (2 copies) or CD-R (2 cop
pies); or
paperr

Statements verifying the identity of above
e copies

A list of no more tha
an 12 items of information sub
bmitted as partt of this request is provided in
n Part B of this form.
Wherre appropriate, the list must meet the require
ements of 37 C FR 1.98(b). 37 CFR 1.605(a
a), 1.610(b)(2)..

[Page 1 of 2]

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information
collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a currently valid OMB Control Number. The OMB Control
Number for this information collection is 0651-0064. Public burden for this form is estimated to average 25 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. Send comments regarding this burden
estimate or any other aspect of this information collection, including suggestions for reducing this burden to the Chief Administrative Officer, United States Patent and Trademark
Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email [email protected]. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS.

Patent No.

PTO/SB/59 (07–12
2)
Approved for use
e through 07/31/201
15. OMB 0651-0064
U.S. Patent and T rademark Office; U.S. DEPARTMEN
NT OF COMMERCE
Under the Paperwork Red
duction Act of 1995,, no persons are re
equired to respond to a collection of in
nformation unless itt displays a valid OMB control number.

10.

A legible copy
c
of each ite
em of information listed in Pa
art B of this form
m, and an Engllish language ttranslation of all necessary
and pertin
nent parts of ea
ach non-English
h language item
m of informatio
on are included
d.
Copies of items of inform
mation that form
m part of the dis
scussion within
n the body of th
he request (see
e 37 CFR 1.605(b)), and
copies of U.S. patents and patent application publicattions, are not rrequired. 37 CF
FR 1.610(b)(7)..

11.

ant portions of each
e
non-paten
nt document th
hat is over 50 p
pages in length (other than the
e request) is
A summarry of the releva
included. The summary
y includes the re
equired citation
ns to the particcular pages con
ntaining the rele
evant portions.. 37 CFR
1.610(b)(8
8).

12.

A separatte, detailed exp
planation of the
e relevance and
d manner of ap
pplying each ite
em of information to each claiim of the
10(b)(5).
patent for which supplem
mental examina
ation is requestted, is included
d. 37 CFR 1.61
w list includes all
a prior or conc
current post-pa
atent Office pro
oceedings (ex p
parte or inter pa
artes reexamin
nation, reissue,
The below
supplemen
ntal examination, post grant re
eview, or inter partes
p
review) involving the p
patent for which
h supplementa
al examination
is being req
quested. 37 CFR
C
1.610(b)(3)). An identifyin
ng number mayy be, e.g., a control no. or reisssue applicatio
on no. Any
prior or con
ncurrent post-p
patent Office prroceedings not listed below arre listed on a sseparate paperr accompanying
g the request.

13.

Type of Prroceeding

Identifying Number
N

Filing D
Date

____________
____________
_____________
____________
____________
_____________
____________
_____________
__
____________
____________
_____________
____________
____________
_____________
____________
_____________
__
____________
____________
_____________
____________
____________
_____________
____________
_____________
__
____________
____________
_____________
____________
____________
_____________
____________
_____________
__
See accompa
anying paper fo
or a list of additiional prior or co
oncurrent post--patent Office p
proceedings in
nvolving the pattent for
w
which supplem
mental examination is requeste
ed. The paper should be a se
eparate sheet ttitled “List of Prior or Concurrrent PostP
Patent Office Proceedings”
P
and must provid
de the type, ide
entifying numbe
er, and filing da
ate of the post-patent Office p
proceeding.
Correspondenc
ce Address: Ple
ease recognize
e, or change, th
he corresponde
ence address ffor the file of th
he patent for wh
hich
14. C
supplemental examination is reque
ested and for the supplementtal examination
n proceeding to
o be:
T
The address as
ssociated with Customer
C
Num
mber:

OR

F
Firm or
IIndividual Nam
me

Addre
ess

City

State

Zip
p

Country
Telep
phone

Email

15. W
WARNING: Information on this form may become public. Credit card
d information should not be
e included on this form.
P
Provide credit card informattion and autho
orization on PTO-2038.
_
____________
_____________
____________
____________
____
Authorize
ed Signature

_____
____________
____________
Date

_
_____________
____________
_____________
____________
____
Typed/Printed Name

____
_____________
____________
_
Registration
n No.

[Page 2 of 2]

PTO/SB/59 (07-12)
Approved for use through 07/31/2015. OMB 0651-0064
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.
(Also referred to as FORM PTO-XXXX)

REQUEST FOR SUPPLEMENTAL EXAMINATION TRANSMITTAL FORM
PART B – LIST OF ITEMS OF INFORMATION – Page 1
Patent number for which supplemental examination is requested ___________________

Issue Date ______________

All items of information (no more than 12) submitted herewith as part of this request for supplemental
examination of the above-identified patent are included in the following list:
Cite
No.1

Document Number
Number-Kind Code2 (if
known)

Publication
Date
MM-DDYYYY

U. S. PATENT DOCUMENTS
Name of Patentee or
Applicant of Cited Document

Pages, Columns, Lines, Where
Relevant Passages or Relevant
Figures Appear

USUSUSUSUSUSUSUSUSUSUSUSCite
1
No.

Foreign Patent
Document
Country Code3-Number45
Kind Code (if known)

Publication
Date
MM-DDYYYY

FOREIGN PATENT DOCUMENTS
Name of Patentee or
Applicant of Cited Document

Pages, Columns, Lines, Where
Relevant Passages or
Relevant Figures Appear

T2

1
Applicant’s unique citation designation number (optional). 2 See Kinds Codes of USPTO Patent Documents at www.uspto.gov or MPEP 901.04. 3 Enter Office that issued
the document, by the two-letter code (WIPO Standard ST.3). 4 For Japanese patent documents, the indication of the year of the reign of the Emperor must precede the serial
number of the patent document. 5Kind of document by the appropriate symbols as indicated on the document under WIPO Standard ST.16 if possible. 6 Applicant is to place a
check mark here if English language Translation is attached.

Page 1 of 2

PTO/SB/59 (07-12)
Approved for use through 07/31/2015. OMB 0651-0064
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.
(Also referred to as FORM PTO-XXXX)

REQUEST FOR SUPPLEMENTAL EXAMINATION TRANSMITTAL FORM
PART B – LIST OF ITEMS OF INFORMATION – Page 2
Patent number for which supplemental examination is requested ___________________
Issue Date ______________
All items of information (no more than 12) submitted herewith as part of this request for supplemental
examination of the above- identified patent are included in the following list:
OTHER DOCUMENTS
Cite
No.1

1

Document Information (include, where appropriate, name of the author, title of the article, book, magazine, journal, serial, symposium, catalog, etc.,
publication date, page(s), volume-issue number(s), publisher, city and/or country where published. If a court document, identify the specific court, the
designation (case citation or numeric designation), the title of the document, and the date submitted in court. If a declaration, include the type (e.g., 37
CFR 1.132 or 1.131), name of declarant, and the date of declaration. If an invoice or sales receipt, include the date issued and the name of the issuer
(e.g., the name of the corporation or other place of business). If a discussion within the body of the request, include the pages of the request on which
the discussion appears, and a description of the discussion (e.g., “discussion in request of why the claims are patentable under 35 U.S.C. 101, pages
7-11.”) For all other materials, include, where appropriate, the title, author, date, and any descriptive information that would describe the document.)

Applicant’s unique citation designation number (optional). 2 Applicant is to place a check mark here if English language Translation is attached.

Page 2 of 2

T2

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