PETITION
TO REVIVE ABANDONED APPLICATION
(TYPE 1)
Applicant: _____________________________________ (Name)
Serial
No.: _________________________
Filed: _____________________________ (Date)
For:
________________________________________________________ (Invention)
Check
one:
o
Petition to revive
o
Petition to accept delayed payment of issue fee
It
is hereby certified that the attached communication is being deposited in the
United States mail as first class mail (or, if applicable, the mail outside the
United States as air mail) in an envelope addressed to:
Commissioner of Patents and
Trademarks
Washington, DC 20231
on _______________________ (Date). This date is more than 3 days before the due
date. The communication is being
sent from
_______________________________ (Location) by
_________________________________________________ (Name).
If
this communication is not filed on time in the US Patent and Trademark Office,
I hereby request that the communication be treated as a petition. In such case, I request that the delay in
prosecuting the application be held to be unavoidable (or, if applicable, that
the delayed payment of the fee be accepted).
I
hereby authorize the petition fee to be charged to account number
_______________
which
is in the name of ________________________________.
Furthermore,
to the best of my knowledge and belief, all statements made herein are true and
were made with the knowledge that willful false statements are unlawful and
punishable by fine or imprisonment, or both.
___________________________________ ___________________
Signature
of Applicant Date
If
person mailing communication is other than Applicant:
___________________________________ ___________________
Signature
of Person Mailing Communication Date