Declaration (Additional Inventors) and Supplemental Priority Data Sheet (French Language)

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PTO/SB/02A (07-07)
Approuvé pour une utilisation jusqu’au XX/XX/XXXX OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
PTO/SB/02A (07-07)
Approved for use through XX/XX/XXXX OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
En vertu du Paperwork Reduction Act de 1995, personne n’est tenu de répondre à une demande d’informations sauf si elle contient un numéro de contrôle OMB valide.
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.

INVENTEUR(S) SUPPLÉMENTAIRE(S)
ADDITIONAL INVENTOR(S)

DÉCLARATION
DECLARATION

Feuille supplémentaire
Supplemental Sheet

Nom du co-inventeur, s’il y a lieu :
Name of Additional Joint Inventor, if any:

Page
Page

sur
of

Une demande a été déposée pour cet inventeur sans signature
A petition has been filed for this unsigned inventor

Prénom (et 2e prénom, s’il y a lieu)
Given Name (first and middle (if any))

Nom
Family Name or Surname

Signature de l’inventeur
Inventor’s Signature

Date
Date

Résidence : Ville
Residence: City

État
State

Pays
Country

Nationalité
Citizenship

Adresse
Mailing Address
Ville
City

État
State

Nom du co-inventeur, s’il y a lieu :
Name of Additional Joint Inventor, if any:

Zip
Code postal

Pays
Country

Une demande a été déposée pour cet inventeur sans signature
A petition has been filed for this unsigned inventor

Prénom (et 2e prénom, s’il y a lieu)
Given Name (first and middle (if any))

Nom
Family Name or Surname

Signature de l’inventeur
Inventor’s Signature

Date
Date

Résidence : Ville
Residence: City

État
State

Pays
Country

Nationalité
Citizenship

Adresse
Mailing Address
Ville
City

État
State

Nom du co-inventeur, s’il y a lieu :
Name of Additional Joint Inventor, if any:

Code postal
Zip

Pays
Country

Une demande a été déposée pour cet inventeur sans signature
A petition has been filed for this unsigned inventor

Prénom (et 2e prénom, s’il y a lieu)
Given Name (first and middle (if any))

Nom
Family Name or Surname

Signature de l’inventeur
Inventor’s Signature

Date
Date

Résidence : Ville
Residence: City

État
State

Pays
Country

Nationalité
Citizenship

Adresse
Mailing Address
Ville
État
Code postal
Pays
City
State
Zip
Country
Cette demande d’informations est requise en vertu de 35 U.S.C. 115 et de 37 CFR 1.63. Ces informations sont obligatoires pour obtenir ou conserver un avantage
par le public qui doit déposer (et par le USPTO qui doit traiter) une demande. La confidentialité est maintenue en vertu de 35 U.S.C. 122 et 37 CFR 1 .11 et 1.14.
Cette demande d’i nformations prendra approximativement 21 minute s, y compris le rassemble ment, la prépa ration et l’env oi du for mulaire de demande rempli à
l’USPTO. Le temps dépendra de chaque cas. Tout commentaire sur le temps requis pour remplir ce formulaire et/ou suggestions pour le réduir e devra (devront)
être env oyé(es) au Chief In formation Officer, U.S . Pa tent and Tr ademark O ffice, U.S . Departm ent of Commer ce, P.O. Box 1450, Al exandria, VA 2231 3-1450.
NE PAS ENV OYER D’ARGENT NI DE FO RMULAIRES REMPLIS À CE TTE ADRESSE. ENVOYER À : Commissioner f or Paten ts, P. O. Box 1 450,

Alexandria, VA 22313-1450.

This collection of information is required by 35 U.S .C. 115 and 3 7 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 p rocess) an application. Confidentiality is gov erned by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 21
minutes to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time w ill 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.
Pour toute assistance liée au formulaire, appelez le 1-800-PTO-9199 (1-800-786-9199) et sélectionnez l’option 2.
If you need assistance in completing the form, call 1-800-PTO-9199 (1-800-786-9199) and select option 2.

PTO/SB/02B (07-07)
Approuvé pour une utilisation jusqu’au XX/XX/XXXX. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
PTO/SB/02B (07-07)
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 contains a valid OMB control number.
En vertu du Paperwork Reduction Act de 1995, personne n’est tenu de répondre à une demande d’informations sauf si elle contient un numéro de contrôle OMB valide.

DÉCLARATION – Feuille de données prioritaires supplémentaire
DECLARATION – Supplemental Priority Data Sheet
Demandes étrangères :
Foreign applications:
Numéro(s) de demande étrangère
précédente
Prior Foreign Application Number(s)

Pays
Country

Date de dépôt à l’étranger
(MM/JJ/AAAA)
Foreign Filing Date
(MM/DD/YYYY)

Priorité non invoquée
Priority Not Claimed

Copie certifiée conforme ci-jointe ?
OUI NON
Certified Copy Attached?
YES NO

Cette demande d’informations est requise en vertu de 35 U.S.C. 115 et de 37 CFR 1.63. Ces informations sont obligatoires pour obtenir ou conserver un avantage
par le public qui doit déposer (et par le USPTO qui doit traiter) une demande. La confidentialité est maintenue en vertu de 35 U.S.C. 122 et 37 CFR 1 .11 et 1.14.
Cette demande d’i nformations prendra approximativement 21 minute s, y compris le rassemble ment, la prépa ration et l’env oi du for mulaire de demande rempli à
l’USPTO. Le temps dépendra de chaque cas. Tout commentaire sur le temps requis pour remplir ce formulaire et/ou suggestions pour le réduir e devra (devront)
être env oyé(es) au Chief In formation Officer, U.S . Pa tent and Tr ademark O ffice, U.S . Departm ent of Commer ce, P.O. Box 1450, Al exandria, VA 2231 3-1450.
NE PAS ENV OYER D’ARGENT NI DE FO RMULAIRES REMPLIS À CE TTE ADRESSE. ENVOYER À : Commissioner for Patents, P.O. Box 1450,
Alexandria, VA 22313-1450.
This collection of information is required by 35 U.S .C. 115 and 3 7 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 p rocess) an application. Confidentiality is gov erned by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 21
minutes to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time w ill 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.
Pour toute assistance liée au formulaire, appelez le 1-800-PTO-9199 (1-800-786-9199) et sélectionnez l’option 2.
If you need assistance in completing the form, call 1-800-PTO-9199 (1-800-786-9199) and select option 2.

OMB Clearance and PRA Burden Statement for PTO/SB/02B
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 21 minutes 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