Microsoft Word - blank

Status: Original and derived artifacts are available for this document.

Download: pdf

Doc code: Oath
Document Description: Oath or declaration filed

PTO/SB/AIA02 (06-12)
Approved for use through XX/XX/XXXX. 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]
This collection of information is required by 35 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 minute 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 Administrative 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.

PTO/SB/AIA02 (06-12)
Approved for use through XX/XX/XXXX 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
Circumstances permitting execution of this substitute statement:
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/SB/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/SB/14 or equivalent) has not been submitted. Thus, a Substitute
Statement Supplemental Sheet (PTO/SB/AIA11 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:
Name:

Date (Optional):

Signature:
Residence (unless provided in an application data sheet, PTO/SB/14 or equivalent):
City

Country

State

Mailing Address (unless provided in an application data sheet, PTO/SB/14 or equivalent)

City

Zip

State

Country

Note: Use an additional PTO/SB/AIA02 form for each inventor who is deceased, legally incapacitated, cannot be found or
reached after diligent effort, or has refused to execute the oath or declaration under 37 CFR 1.63.
[Page 2 of 2]

OMB Clearance and PRA Burden Statement for PTO/SB/AIA02
This collection of information is required by 37 CFR 1.137. 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, 1.14 and 41.6. This form is estimated to
take 1 minute 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 Administration 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: Mail Stop Petition, Commissioner for Patents, P.O. Box 1450, Alexandria, VA
22313-1450.

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 Act.
However, routine uses of this information may include disclosure to the following: to law enforcement and investigation in the event that the system
of records indicates a violation or potential violation of law; to a Federal, state, local, or international agency, in response to its request; to an agency,
organization, or individual for the purpose of performing audit or oversight operations as authorized by law; to non-federal personnel under contract
to the agency; to a court for adjudication and litigation; to the Department of Justice for Freedom of Information Act (FOIA) assistance; to members of
congress working on behalf of an individual; to the Office of Personnel Management (OPM) for personnel research purposes; to National Archives and
Records Administration for inspection of records; and to the Office of Management and Budget (OMB)for legislative coordination and clearance.
Failure to provide any part of the requested information 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