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DECLARATION FOR PATENT APPLICATION

DECLARATION FOR PATENT APPLICATION

 

 

I declare that my residence, address and citizenship are:

 

Full name of sole or first inventor:  _________________________________________  Citizenship: _________________________________________________________

Residence: __________________________________________________________

___________________________________________________________________

Address: ____________________________________________________________

 

Full name of second joint inventor, if any:  ___________________________________

Citizenship: _________________________________________________________

Residence: __________________________________________________________

___________________________________________________________________

Address: ____________________________________________________________

 

 

I am the sole inventor (or a joint inventor, if applicable) of the subject matter for which I am seeking a patent.  The specification is attached hereto (or was filed on __________

________________ (Date) as application number _____________________________).  I have reviewed and understand the contents of this specification.  I also recognize that I must disclose any information that is material to the examination of this application.

 

Under section 119 of Title 35 of the United States Code, I claim foreign priority benefits for any foreign application(s) for a patent or inventor’s certificate which is listed below.  I have also listed below any foreign application for a patent or inventor’s certificate which was filed prior to the application on which my claim for priority is based.

 

     Prior Foreign Application(s):

______________________________ (Number)

______________________________ (Country)

______________________________ (Month/Day/Year filed)

       Priority Claimed?       Yes ______  No ______

 

______________________________ (Number)

______________________________ (Country)

______________________________ (Month/Day/Year filed)

       Priority Claimed?      Yes ______  No ______

 

Under section 120 of Title 35 of the United States Code, I also claim the benefit of the following United States application(s):

 

     United States Applications:

____________________________ (Application Serial Number.)

____________________________ (Date Filed)

____________________________ (Status:  patented, pending, abandoned)

 

____________________________ (Application Serial Number.)

____________________________ (Date Filed)

____________________________ (Status:  patented, pending, abandoned)

 

I appoint __________________________________________________ (Name) as my attorney and/or agent for the purpose of prosecuting this application and for conducting all business in connection therewith.

 

All telephone calls and all correspondence should be addressed to:

______________________________________________________ (telephone number)

______________________________________________________________ (address)

All statements made herein are, to the best of my knowledge, true.  Furthermore, I recognize that willful false statements are unlawful and are punishable by fine or imprisonment.

 

 

___________________________________                       ___________________

Signature of Inventor                                                                      Date

 

 

___________________________________                       ___________________

Signature of Inventor                                                                      Date

 



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