PTO/SB/03A Declaration (37 CFR 1.63) for Plant Application Using an

PTO/SB/03A (09-12)
Approved for use through XX/XX/XXXX. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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DECLARATION (37 CFR 1.63) FOR PLANT APPLICATION USING AN APPLICATION
DATA SHEET (37 CFR 1.76)

Title of Invention

As the below named inventor(s), I/we declare that:
This declaration is directed to:
The attached application, or
Application No. _________________________ filed on ________________________________,
as amended on ______________________________ (if application);
I/we believe that I/we am/are the original and first inventor(s) of the new and distinct variety of plant which is claimed and for
which a plant patent is sought;
I/we have asexually reproduced the plant to which this application applies;
The plant was found in a cultivated area (check this box for a newly found plant only);
I/we have reviewed and understand the contents of the above-identified application, including the claims, as amended by any
amendment specifically referred to above;
I/we acknowledge the duty to disclosure to the United State Patent and Trademark Office all information known to me/us to be
material to patentability as defined in 37 CFR 1.56, including for continuation-in-part applications, material information which
became available between the filing date of the prior application and the national or PCT international filing date of the
continuation-in-part. The above-identified application was made or authorized to be made by me/us

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.
All statements made herein of my/our own knowledge are true, all statements made herein 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
are punishable by fine or imprisonment, or both, under 18 U.S.C. 1001, and may jeopardize the validity of the application or
any patent issuing thereon. I hereby acknowledge that any willful false statement made in this declaration is punishable under
18 U.S.C. 1001 by fine or imprisonment of not more than five (5) years, or both.
FULL NAME OF INVENTOR(S)
Inventor one: ___________________________________________________ Date: _______________________________
Signature: _____________________________________________________ Citizen of: ___________________________
Additional inventors or a legal representative are being named on _____________ additional form(s) attached hereto.
This collection of information is required by 37 U.S.C. 115 and 37 CFR 1.63. 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 and 1.14. This collection is estimated to take 1
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 Information
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.

If you need assistance in completing the form, call 1-800-PTO-9199 and select option 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. Accordingly,
pursuant to the requirements of the Act, please be advised that: (1) the general authority for the
collection of this information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary;
and (3) the principal purpose for which the information is used by the U.S. Patent and Trademark
Office is to process and/or examine your submission related to a patent application or patent. If you do
not furnish the requested information, the U.S. Patent and Trademark Office may not be able to
process and/or examine your submission, which may result in termination of proceedings or
abandonment of the application or expiration of the patent.
The information provided by you in this form will be subject to the following routine uses:
1. The information on this form will be treated confidentially to the extent allowed under the
Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from
this system of records may be disclosed to the Department of Justice to determine whether
disclosure of these records is required by the Freedom of Information Act.
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amended, pursuant to 5 U.S.C. 552a(m).
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World Intellectual Property Organization, pursuant to the Patent Cooperation Treaty.
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the Atomic Energy Act (42 U.S.C. 218(c)).
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part of that agency’s responsibility to recommend improvements in records management
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be made in accordance with the GSA regulations governing inspection of records for this
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8. A record from this system of records may be disclosed, as a routine use, to the public after
either publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent
pursuant to 35 U.S.C. 151. Further, a record may be disclosed, subject to the limitations of 37
CFR 1.14, as a routine use, to the public 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 inspection or an
issued patent.
9. A record from this system of records may be disclosed, as a routine use, to a Federal, State,
or local law enforcement agency, if the USPTO becomes aware of a violation or potential
violation of law or regulation.