PTO/SB/130 Petition to Make Special Based on Age for Advancement of

Doc code: PET.OP.AGE
Description: Petition to make special based on age/health
PTO/SB/130 (01-19)
Approved for use through XX/XX/XXXX. OMB 0651-0031
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 contains a valid OMB control number

PETITION TO MAKE SPECIAL BASED ON AGE
FOR ADVANCEMENT OF EXAMINATION UNDER 37 CFR 1.102(c)(1)
Application Information
Application
Number
Attorney Docket
Number (optional)
First Named
Inventor

Confirmation
Number

Filing
Date

Art Unit

Examiner

Title of Invention
Attention: Office of Petitions
An application may be made special for advancement of examination upon filing of a petition showing that the applicant is
65 years of age, or more. No fee is required with such a petition. See 37 CFR 1.102(c)(1) and MPEP 708.02 (II).
APPLICANT HEREBY PETITIONS TO MAKE SPECIAL FOR ADVANCEMENT OF EXAMINATION IN THIS APPLICATION UNDER
37 CFR 1.102(c)(1) and MPEP 708.02 (II) ON THE BASIS OF THE APPLICANT'S AGE.
A grantable petition requires one of the following items:
(1) Statement by one named inventor in the application that he/she is 65 years of age, or more; or
(2) Certification by a registered attorney/agent having evidence such as a birth certificate, passport, driver's license,
etc. showing one named inventor in the application is 65 years of age, or more.
Name of inventor who is 65 years of age, or older
Given Name

Middle Name

Family Name

Suffix

A signature of the applicant or representative is required in accordance with 37 CFR 1.33 and 11.18. Please see 37 CFR 1.4(d)
for the format of the signature.
Select (1) or (2):
(1) I am an inventor in this application and I am 65 years of age, or more.
(2) I am an attorney or agent registered to practice before the Patent and Trademark Office, and I certify that I am in
possession of evidence, and will retain such in the application file record, showing that the inventor listed above is
65 years of age, or more.
Signature

Date
(YYYY-MM-DD)

Name

Registration
Number

This collection of information is required by 37 CFR 1.102(c)(1). The information is required to obtain or retain a benefit by the public, which is to file (and by the
USPTO to process) a petition to make special based on age for advancement of examination. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.14. This
collection is estimated to take 2 hours 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 Administrative Officer, U.S. Patent and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND
COMPLETED FORMS TO THE CHIEF INFORMATION OFFICER. Submit completed forms electronically over EFS-Web, or mail 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. 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
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However, routine uses of this information may include disclosure to the following: to law enforcement and investigation
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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