PTO/SB/01 (02-08)
Approved for use through 06/30/2010. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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Attorney Docket
Number
First Named Inventor
COMPLETE IF KNOWN
Application Number
Filing Date
Art Unit
DECLARATION FOR UTILITY OR
DESIGN
PATENT APPLICATION
(37 CFR 1.63)
Declaration Declaration
Submitted OR Submitted after Initial
With Initial Filing (surcharge
Filing (37 CFR 1.16 (f))
required)
Examiner Name
I hereby declare that: (1) Each inventor’s residence, mailing address, and citizenship are as stated below next to their name;
and (2) I believe the inventor(s) named below to be the original and first inventor(s) of the subject matter which is claimed and
for which a patent is sought on the invention entitled:
(Title of the Invention)
the specification of which
is attached hereto
OR
was filed on (MM/DD/YYYY)
as United States Application Number or PCT International
Application Number
and was amended on (MM/DD/YYYY)
(if applicable).
I hereby state that I have reviewed and understand the contents of the above identified specification, including the claims, as
amended by any amendment specifically referred to above.
I acknowledge the duty to disclose information which is 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 application.
A