Approved for use through 10/31/2008. OMB 0651-0031
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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DISCLAIMER IN PATENT UNDER 37 CFR 1.321(a)
Name of Patentee
Docket Number (Optional)
Date Patent Issued
Title of Invention
I hereby disclaim the following complete claims in the above identified patent:
The extent of my interest in said patent is (if assignee of record, state liber and page, or reel and frame, where
assignment is recorded):
The fee for this disclaimer is set forth in 37 CFR 1.20(d).
Patentee claims small entity status. See 37 CFR 1.27.
Small entity status has already been established in this case, and is still proper.
A check in the amount of the fee is enclosed.
Payment by credit card. Form PTO-2038 is attached.
The Director is hereby authorized to charge any fees which may be required or credit any
overpayment to Deposit Account No. ________________ .
WARNING: Information on this form may become public. Credit card information should not
be included on this form. Provide credit card information and authorization on PTO-2038.
Signed at ,
State of ,
Registration Number, if
Typed or printed name of patentee/ attorney or agent of record
City, State, Zip Code or Foreign Country as applicable
This collection of information is required by 37 CFR 1.321. 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 estim