Overview of Examples

Inventor’s Oath or Declaration Examples Featuring “Best Practices” in Use of Inventor’s Oath or Declaration Forms The Office is providing four examples to aid applicants in determining which inventor’s oath or declaration forms must be submitted to the agency for an application filed after September 16, 2012 (the effective date of the inventor’s oath or declaration provision of the America Invents Act (AIA)). Each example sets forth a hypothetical fact pattern followed by (i) the Office’s recommendation of the inventor’s oath or declaration and other related forms to be filed; and (ii) the recommended forms filled out to reflect the hypothetical facts. The Office’s recommendation is intended to reflect what the Office views to be a “best practice” for compliance in each example. Notably though, the inventor’s oath or declaration provision of the AIA was intended to give flexibility to inventor’s when filing oaths or declarations with the Office. There are other form options for an applicant to file and still comply with the inventor’s oath or declaration provision of the AIA. Thus, the Office’s recommendation reflects one way to satisfy the inventor’s oath or declaration requirements of the AIA—what the Office views to be the best way—but other equally compliant ways exist as well.

Overview of Examples Example

Topic

Recommended Forms Inventor’s Oath or Declaration Form Number AIA/01 AIA/01 AIA/02

Application Data Sheet Form Number

1 2

Inventors as Applicants Inventors as Applicants with Substitute Statements Needed

AIA/14 AIA/14

3

Corporate Assignee as Applicant

AIA/01

AIA/14

4

Corporate Assignee as Application with Substitute Statements Needed

AIA/01 AIA/02

AIA/14

Example 1 Inventors as Applicants FACTS: Inventors: Adam Smith, Matthew Jones, and Meryl Brown Applicant: Inventors (Adam Smith, Matthew Jones, and Meryl Brown) Is a patent practitioner representing the Applicant? No, the inventors are prosecuting the application pro se (i.e., without a registered patent practitioner).

RECOMMENDED INVENTOR’S OATH/DECLARATION FORMS: Inventor’s Oath or Declaration Submit Form AIA/01 (Declaration for Utility or Design Application Using an Application Data Sheet (37 CFR 1.76)) for each inventor (i.e., three forms total). The three declaration forms may be submitted with the application (recommended to avoid payment of a surcharge) or may be submitted together or serially during prosecution until required by the USPTO.

Application Data Sheet (Form AIA/14) •

In the Inventor Information section, print or type the legal name, residence, and mailing address of all three inventors.

•

In the Applicant Information section, leave blank as stated in the form. (If the Applicant Information section is left blank, the inventors are considered the applicant by the USPTO.)

•

In the Signature section, have all three inventors sign the ADS, unless all three are giving power of attorney to one or more of them (Form AIA/81, entitled Power of Attorney to One or More of the Joint Inventors and Change of Correspondence Address). If power is given, the inventor(s) with power can sign the ADS on behalf of all of the inventors.

PTOIAIA/01 (06-12) Approved for use through 01/3112014. 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 displays a valid OMB control number.

DECLARATION (37 CFR 1.63) FOR UTILITY OR DESIGN APPLICATION USING AN APPLICATION DATA SHEET (37 CFR 1.76) Title of Invention

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As the below named inventor, I hereby declare that: This declaration is directed to:

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The attached application, or United States application or PCT international application number __________ filed on _ _ _ _ _ _ _ _ _ _ _ _ _ __

The above-identified application was made or authorized to be made by me.

I believe that I am the original inventor or an original joint inventor of a claimed invention in the application.

I hereby acknowledge that any willful false statement made in this declaration is punishable under 18 U.S.C. 1001 by fin e or imprisonment of not more than five (5) years, or both.

WARNING: Petitioner/applicant is cautioned to avoid submitting personal information in documents filed in a patent application that may contribute to identity theft. Personal information such as social security numbers, bank account numbers, or credit card numbers (other than a check or credit card authorization form PT0-2038 submitted for payment purposes) is never required by the USPTO to support a petition or an application. If this type of personal information is included in documents submitted to the USPTO, petition ers/applicants should consider redacting such personal information from the documents before submitting them to the USPTO. Petitioner/applicant is advised that the record of a patent application is available to the public after publication of the application (unless a non-publication request in compliance with 37 CFR 1.213(a) is made in the application) or issuance of a patent. Furthermore, the record from an abandon ed application may also be availabl e to the public if the application is referenced in a published application or an issued patent (see 37 CFR 1.14). Checks and credit card authorization forms PT0-2038 submitted for payment purposes are not retained in the application file and the refore are not publicly availabl e.

LEGAL NAME OF INVENTOR

Inventor:

10 _1_1_2_____ Date (Optional) :_1_2_1_

Adam Smith

Signature: /Adam

Smith/

Note: An application data sheet (PTO/SB/14 or equivalent), including naming the entire inventive entity, must accompany this form or must have been previously filed. Use an additional PTO/AIA/01 form for each additional inventor. This collection of information is required by 35 U.S.C. 115 and 37 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 process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 1 minute to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any comments on the amount oftime you require to complete this form and/or suggestions for reducing this burden , should be sent to the Chief Information Officer, U.S. Patent and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Al exandria, 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. If you need assistance in completing the form, ca/11-800-PT0-9199 and select option 2.

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 Accordingly, pursuant to the requirements of the Act, please be advised that: (1) the general authority for the collection of this information is 35 U.S. C. 2(b)(2); (2) furnishing of the information solicited is voluntary; and (3) the principal purpose for which the information is used by the U.S. Patent and Trademark Office is to process and/or examine your submission related to a patent application or patent If you do not furnish the requested information, the U.S. Patent and Trademark Office may not be able to process and/or examine your submission, which may result in termination of proceedings or abandonment of the application or expiration of the patent The information provided by you in this form will be subject to the following routine uses: 1.

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The information on this form will be treated confidentially to the extent allowed under the Freedom of Information Act (5 U.S. C. 552) and the Privacy Act (5 U.S.C 552a). Records from this system of records may be disclosed to the Department of Justice to determine whether disclosure of these records is required by the Freedom of Information Act A record from this system of records may be disclosed, as a routine use, in the course of presenting evidence to a court, magistrate, or administrative tribunal, including disclosures to opposing counsel in the course of settlement negotiations. A record in this system of records may be disclosed, as a routine use, to a Member of Congress submitting a request involving an individual, to whom the record pertains, when the individual has requested assistance from the Member with respect to the subject matter of the record. A record in this system of records may be disclosed, as a routine use, to a contractor of the Agency having need for the information in order to perform a contract Recipients of information shall be required to comply with the requirements of the Privacy Act of 197 4, as amended, pursuant to 5 U.S. C. 552a(m). A record related to an International Application filed under the Patent Cooperation Treaty in this system of records may be disclosed, as a routine use, to the International Bureau of the World Intellectual Property Organization, pursuant to the Patent Cooperation Treaty. A record in this system of records may be disclosed, as a routine use, to another federal agency for purposes of National Security review (35 U.S. C. 181) and for review pursuant to the Atomic Energy Act (42 USC 218(c)). A record from this system of records may be disclosed, as a routine use, to the Administrator, General Services, or his/her designee, during an inspection of records conducted by GSA as part of that agency's responsibility to recommend improvements in records management practices and programs, under authority of 44 U.S. C. 2904 and 2906. Such disclosure shall be made in accordance with the GSA regulations governing inspection of records for this purpose, and any other relevant (i.e., GSA or Commerce) directive. Such disclosure shall not be used to make determinations about individuals. A record from this system of records may be disclosed, as a routine use, to the public after either publication of the application pursuant to 35 U.S. C. 122(b) or issuance of a patent pursuant to 35 U.S. C. 151. Further, a record may be disclosed, subject to the limitations of 37 CFR 1.14, as a routine use, to the public if the record was filed in an application which became abandoned or in which the proceedings were terminated and which application is referenced by either a published application, an application open to public inspection or an issued patent A record from this system of records may be disclosed, as a routine use, to a Federal, State, or local law enforcement agency, if the USPTO becomes aware of a violation or potential violation of law or regulation.



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Inventor:

Matthew Jones

Signature: /Matthew

Date (Optional) :_1_2_10 _4 _1_1_2_ _ _ __

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Inventor:

Date (Optional) :_1_2_IO_?_I_1_2_ _ _ __

Meryl Brown

Signature: /Meryl

Brown/



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PTO/AIA/14 (OB-12) Approved for use through 01/31/2014. 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 OM B control number.

Attorney Docket Number

Application Data Sheet 37 CFR 1.76 Title of Invention

Application Number

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The application data sheet is part of the provisional or nonprovisional application for which it is being submitted. The following form contains the bibliographic data arranged in a format specified by the United states Patent and Trademark Office as outlined in 37 CFR 1.76. This document may be completed electronically and submitted to the Office in electronic format using the Electronic Filing System (EFS) or the document may be printed and included in a paper filed application.

Secrecy Order 37 CFR 5.2

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Portions or all of the application associated with this Application Data Sheet may fall under a Secrecy Order pursuant to 37 CFR 5.2 (Paper filers only. Applications that fall under Secrecy Order may not be filed electronically.)

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All Inventors Must Be Listed - Additional Inventor Information blocks may be generated within this form by selecting the Add button.

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Correspondence Information: Enter either Customer Number or complete the Correspondence Information section below. For further information see 37 CFR 1.33(a).

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An Address is being provided for the correspondence Information of this application.

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Suggested Class (if any)

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Suggested Technology Center (if any) Total Number of Drawing Sheets (if any)

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Publication Information: D Request Early Publication (Fee required at time of Request 37 CFR 1.21 9) Request Not to Publish. I hereby re quest that the attached application not be published under 35 U.S. C. 122(b) and certify that the invention disclosed in the attached applicatio n has not and will not be the subject of an application filed in another country, or under a multilateral international agreement, that req uires publication at eighteen months after fili ng.

EFS W eb 2.2.5



Attorney Docket Number Application Number

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Representative Information: Representative information should be provided for all practitioners having a power of attorney in the application. Providing this information in the Application Data Sheet does not constitute a power of attorney in the application (see 37 CFR 1.32). Either enter Customer Number or complete the Representative Name section below. If both sections are completed the customer Number will be used for the Representative Information during processing.

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Limited Recognition (37 CFR 11.9)

Domestic Benefit/National Stage Information: This section allows for the applicant to either claim benefit under 35 U.S. C. 119(e), 120, 121, or 365(c) or indicate National Stage entry from a PCT application. Providing this information in the application data sheet constitutes the specific reference required by 35 U.S.C. 119(e) or 120, and 37 CFR 1.78. Prior Application Status

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Foreign Priority Information: This section allows for the applicant to claim benefit of fore ign priority a nd to ide ntify any prior fore ign a pplication for which priority is not claimed . Providing this informati on in th e application data sheet co nstitutes th e claim fo r pri ority as required by 35 U.S. C . 11 9(b) and 37 CFR 1.55(a).

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Authorization to Permit Access: Authorization to Permit Access to the Instant Application by the Parti cipating Offices

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Priority Claimed

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If checked, the undersigned hereby grants the USPTO authority to provide the European Patent Office (EPO), the Japan Patent Office (JPO), the Korean Intellectual Property Office (KIPO), the World Intellectual Property Office (WI PO), and any other intellectual property offices in which a foreign application claiming priority to the instant patent application is filed access to the instant patent application. See 37 CFR 1.14(c) and (h). This box should not be checked if the applicant does not wish the EPO, JPO, KIPO, WI PO, or other intellectual property office in which a foreign application claiming priority to the instant patent application is filed to have access to the instant patent application. In accordance with 37 CFR 1.14(h)(3), access will be provided to a copy of the instant patent application with respect to: 1) the instant patent application-as-filed; 2) any foreign application to which the instant patent application claims priority under 35 U.S. C. 119(a)-(d) if a copy of the foreign application that satisfies the certified copy requirement of 37 CFR 1.55 has been filed in the instant patent application; and 3) any U.S. application-as-filed from which benefit is sought in the instant patent application. In accordance with 37 CFR 1.14(c), access may be provided to information concerning the date of filing this Authorization.

Applicant Information: Providing assignment information in this section does not substitute for compliance with any requirement of part 3 of Title 37 of CFR to have an assignment recorded by the Office.

Applicant

1

If the applicant is th e inve ntor (or the remai ning joint inventor or inve ntors under 37 CFR 1.45), this section should not be completed. The information to be provided in this section is the name and address of the legal representative who is the applicant under 37 CFR 1.43; or th e name and address of the assignee, person to whom th e inventor is under an obligation to assign the invention, or person who otherwise shows sufficie nt proprietary interest in th e matter who is the applicant under 37 CFR 1.46. If the applicant is an applicant under 37 CFR 1.46 (assignee, person to whom the inventor is obligated to assign, or person who otherwise shows sufficie nt proprietary interest) togeth er with one or more joint inventors, then the joint inve ntor or inventors who are also th e applicant should be identified in this section.

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Legal Representative under 35 U.S. C . 117

Person to whom the inventor is obligated to assign.

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If applicant is the legal representative, indicate the authority to file the patent application, the inventor is:

l"'J Name of the Deceased or Legally Incapacitated Inventor

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Mailing Address Information: Address 1 Address 2

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Non-Applicant Assignee Information: Providing assignment information in this section does not subsitute for compliance with any requirement of part 3 of Title 37 of CFR to have an assignment recorded by the Office.

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1

Complete this section only if non-aplicant assignee information is desired to be included on the patent application publication in accordance with 37 CFR 1.215(b). Do not include in this section an applicant under 37 CFR 1.46 (assignee, person to whom the inventor is obligated to assign, or person who otherwise shows sufficient proprietary interest), as the patent application publication will include the name of the applicant(s).

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NOTE: This form must be signed in accordance with 37 CFR 1.33. See 37 CFR 1.4 for signature requirements and certifications Signature First Name

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This collection of information is required by 37 CFR 1. 76. 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 1.14. This collection is estimated to take 23 minutes to complete, including gathering, preparing, and submitting the completed application data sheet 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 Information 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.

EFS W eb 2.2.5

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. Accordingly, pursuant to the requirements of the Act, please be advised that: (1) the general authority for the collection of this information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary; and (3) the principal purpose for which the information is used by the U.S. Patent and Trademark Office is to process and/or examine your submission related to a patent application or patent. If you do not furnish the requested information, the U.S. Patent and Trademark Office may not be able to process and/or examine your submission, which may result in termination of proceedings or abandonment of the application or expiration of the patent. The information provided by you in this form will be subject to the following routine uses: 1.

The information on this form will be treated confidentially to the extent allowed under the Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C. 552a). Records from this system of records may be disclosed to the Department of Justice to determine whether the Freedom of Information Act requires disclosure of these records.

2.

A record from this system of records may be disclosed, as a routine use, in the course of presenting evidence to a court, magistrate, or administrative tribunal , including disclosures to opposing counsel in the course of settlement negotiations.

3.

A record in this system of records may be disclosed , as a routine u se, to a Member of Congress submitting a request involving an individual, to whom th e record pertains, when the individual has requested assistance from th e Member with respect to th e subject matter of the record.

4.

A record in this system of records may be disclosed , as a routine u se, to a contractor of the Agency having need for the information in order to perform a contract. Recipients of information shall be required to comply with the requirements of the Privacy Act of 1974, as amended, pursuant to 5 U.S.C. 552a(m).

5.

A record related to an International Application filed under the Patent Cooperation Treaty in this system of records may be disclosed, as a routine use , to th e Internation al Bureau of the World Intellectu al Property Organization, pursuant to th e Patent Cooperation Treaty.

6.

A record in this system of records may be disclosed, as a routine use, to another federal agency for purposes of National Security review (35 U. S.C. 181) and for review pursuant to the Atomic Energy Act (42 U.S.C. 218(c)).

7.

A record from this system of records may be disclosed, as a routine use, to the Administrator, General Services, or his/her designee, during an inspection of records conducted by GSA as part of that agency's responsibility to recommend improvements in records management practices and programs , under authority of 44 U.S. C. 2904 and 2906. Such disclosure shall be made in accordance with th e GSA regulations governing inspection of records for this purpose, and any other relevant (i.e., GSA or Commerce) directive. Such disclosure shall not be used to make determinations about individuals.

8.

A record from this system of records may be disclosed, as a routine use, to the public after either publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent pursuant to 35 U.S.C. 151. Further, a record may be disclosed, subj ect to the limitations of 37 CFR 1.14, as a routine use, to th e public if th e record was filed in an appli cation which became abandoned or in which th e proceedings were terminated and which application is referenced by either a published application, an application open to public inspections or an issued patent.

9.

A record from this system of records may be disclosed, as a routine use, to a Federal, state , or local law enforcement agency, if the USPTO becomes aware of a violation or potential violation of law or regulation.

EFS Web 2.2.5

Example 2 Inventors as Applicants with Substitute Statements Needed

FACTS: Inventors: Adam Smith, Mary Williams, and Hiram Stein. Mary Williams is deceased. Hiram Stein does not want to file a patent application for the invention and has refused to sign an oath or declaration. Applicant: Inventor Adam Smith and John Williams, the legal representative for Mary Williams Is a patent practitioner representing the Applicant? No, the inventors are prosecuting the application pro se (without a registered patent practitioner).

RECOMMENDED INVENTOR’S OATH/DECLARATION FORMS: Inventor’s Oath or Declaration •

Submit one Form AIA/01 (Declaration for Utility or Design Application Using an Application Data Sheet (37 CFR 1.76)) identifying and signed by Adam Smith.

•

Submit one Form AIA/02 (Substitute Statement in Lieu of an Oath or Declaration for Utility or Design Patent Application (35 U.S.C. 115(d) and 37 CFR 1.64)) signed by Adam Smith on behalf of non-signing inventor Hiram Stein. Since an ADS is being submitted, it is not necessary to list the residences and mailing addresses for Hiram Stein or Adam Smith.

•

Submit one Form AIA/02 (Substitute Statement in Lieu of an Oath or Declaration for Utility or Design Patent Application (35 U.S.C. 115(d) and 37 CFR 1.64)) signed by John Williams on behalf of deceased inventor Mary Williams. Since an ADS is being submitted, it is not necessary to list the residence and mailing address for John Williams. (Note: The residence and mailing address are not required for Mary Williams since she is deceased.)

The AIA/01 and AIA/02 forms may be submitted with the application (recommended to avoid payment of a surcharge) or may be submitted together or serially during prosecution until required by the USPTO.

ADS (Form AIA/14) •

In the Inventor Information section, print or type the legal name for all three inventors, and residence and mailing address for Adam Smith and Hiram Stein. (Note: The residence and mailing address are not required for Mary Williams since she is deceased.)

•

In the Applicant Information section: o Inventor Adam Smith and legal representative John Williams should be listed. o Mary Williams is not considered an applicant because she is deceased, and therefore her legal representative John Williams is an applicant party. o Hiram Stein is not an applicant because he does not want to file the patent application or sign an oath or declaration.

•

Adam Smith and John Williams must sign the ADS, unless both give power of attorney to one to sign correspondence on behalf of both parties (PTO Form AIA/8, entitled Power of Attorney to One or More of the Joint Inventors and Change of Correspondence Address).



Semiconductor


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Inventor:

Adam Smith

Signature: /Adam

Date (Optional) :_ _ _ _ _ _ _ _ __

Smith/



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Doc code: Oath Document Description: Oath or declaration filed

PTO/AI.AJ02 (06-12) Approved for use through 01/31/2014. 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 displays a valid OMB control number.

SUBSTITUTE STATEMENT IN LIEU OF AN OATH OR DECLARATION FOR UTILITY OR DESIGN PATENT APPLICATION (35 U.S.C. 115(d) AND 37 CFR 1.64) Title of Invention

Semiconductor

This statement is directed to:

II] The attached application, OR

D United States application or PCT international application number

filed on

LEGAL NAME of inventor to whom this substitute statement applies: (E.g., Given Name (first and middle (if any)) and Family Name or Surname)

Mary Williams Residence (except for a deceased or legally incapacitated inventor):

City

State Mailing Address (except for a deceased or legally incapacitated inventor) :

r ity

State

Countrv

Zio

Country

I believe the above-named inventor or joint inventor to be the original inventor or an original joint inventor of a claimed invention in the applicati on.


I hereby acknowledge th at any willful false statement made in thi s state ment is punishable under 18 U.S. C . 1001 by fine or imprisonment of not more than five (5) years, or both.

Relationship to the inventor to whom t his substitute statement applies:

•

Legal Rep resentative (for deceased or legally incapacitated inventor only) ,

D Assignee, D Person to whom the inventor is under an obligation to assign, D Person who otherwise shows a sufficient proprietary interest in the matter (petition under 37 C FR 1.46 is required), or D Joint Inventor. [Page 1 of 2]

This collection of information is required by 35 U. S.C. 115 and 37 CFR 1.63. Th e information is r equired t o obtain or retain a b enefit by the public which is to fil e (and by the USPTO to process) an applicati on. Confidenti ality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 1 minute t o complete, in cluding gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the indiv idual case. Any comments on the amount oftime you require t o complete this form and/or suggestions for reducing this burden , shoul d be sent to the Ch ief In formation 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 CO MPLETED FORMS TO TH IS ADDRESS . SEND TO: Commiss ioner for Patents, P. O. Box 1450, Al exandria, VA 2231 3-1 450. If you need assistance in completing the form, ca/11-800-PT0-9199 and select option 2.

PTO/SB/AIA02 (06-12) Approved for use through 01/31/2014. 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 displays a valid OMB control number.

( _________________s_u_s_s_r_lr_u_r_E_s_r_A_r_E_M_E_N_r________________) Circumstances permitting execution of this substitute statement:

Ill D D D

Inventor is deceased, Inventor is under legal incapacity, Inventor cannot be found or reached after diligent effort, or Inventor has refused to execute the oath or declaration under 37 CFR 1.63.

If there are joint inventors, please check the appropriate box below: data sheet under 37 CFR 1. 76 (PTO/AIN14 or equivalent) naming the entire inventive entity has been Ill orAnisapplication currently submitted. OR

D

An application data sheet under 37 CFR 1. 76 (PTO/AIA/14 or equivalent) has not been submitted. Thus, a Substitute Statement Supplemental Sheet (PTO/AIA/11 or equivalent) naming the entire inventive entity and providing inventor information is attached. See 37 CFR 1.64(b).

WARNING: Petitioner/applicant is cautioned to avoid submitting personal information in documents filed in a patent application that may contribute to identity theft. Personal information such as social security numbers, bank account numbers, or credit card numbers (other than a check or credit card authorization form PT0-2038 submitted for payment purposes) is never required by the USPTO to support a petition or an application. If th is type of personal information is included in documents submitted to the USPTO, petitioners/applicants should consider redacting such personal information from th e documents before submitting them to the USPTO. Petitioner/applicant is advised that the record of a patent application is available to the public after publication of th e application (unless a non-publication request in compliance with 37 CFR 1.213(a) is made in the application) or issuance of a patent. Furthermore, th e record from an abandoned application may also be available to the public if th e application is referenced in a published application or an issued patent (see 37 C FR 1.14). Checks and credit ca rd a uthorization forms PT0-2038 submitted for payment purposes are not retained in the application file and therefore are not publicly available.

PERSON EXECUTING THIS SUBSTITUTE STATEMENT:

12/03/12

John Williams /John Williams/ Signature: Name:

Date (Optional):

Residence (unless provided in an application data sheet, PTO/AIN14 or equivalent):

City Country State Mailing Address (unless provided in an application data sheet, PTO/AIA/14 or equivalent)

City

Zip

State

Country

Note: Use an additional PTO/AIN02 form for each inve ntor who is deceased , legally incapacitated, cannot be found or reached after diligent effort, or has refused to execute the oath or declaration under 37 CFR 1.63. [Pag e 2 of 2]


2.

3.

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7.

8.

9.

The information on this form will be treated confidentially to the extent allowed under the Freedom of Information Act (5 U.S. C. 552) and the Privacy Act (5 U.S.C 552a). Records from this system of records may be disclosed to the Department of Justice to determine whether disclosure of these records is required by the Freedom of Information Act A record from this system of records may be disclosed, as a routine use, in the course of presenting evidence to a court, magistrate, or administrative tribunal, including disclosures to opposing counsel in the course of settlement negotiations. A record in this system of records may be disclosed, as a routine use, to a Member of Congress submitting a request involving an individual, to whom the record pertains, when the individual has requested assistance from the Member with respect to the subject matter of the record. A record in this system of records may be disclosed, as a routine use, to a contractor of the Agency having need for the information in order to perform a contract Recipients of information shall be required to comply with the requirements of the Privacy Act of 1974, as amended, pursuant to 5 U.S. C. 552a(m). A record related to an International Application filed under the Patent Cooperation Treaty in this system of records may be disclosed, as a routine use, to the International Bureau of the World Intellectual Property Organization, pursuant to the Patent Cooperation Treaty. A record in this system of records may be disclosed, as a routine use, to another federal agency for purposes of National Security review (35 U.S. C. 181) and for review pursuant to the Atomic Energy Act (42 USC 218(c)). A record from this system of records may be disclosed, as a routine use, to the Administrator, General Services, or his/her designee, during an inspection of records conducted by GSA as part of that agency's responsibility to recommend improvements in records management practices and programs, under authority of 44 U.S. C. 2904 and 2906. Such disclosure shall be made in accordance with the GSA regulations governing inspection of records for this purpose, and any other relevant (i.e., GSA or Commerce) directive. Such disclosure shall not be used to make determinations about individuals. A record from this system of records may be disclosed, as a routine use, to the public after either publication of the application pursuant to 35 U.S. C. 122(b) or issuance of a patent pursuant to 35 U.S. C. 151. Further, a record may be disclosed, subject to the limitations of 37 CFR 1.14, as a routine use, to the public if the record was filed in an application which became abandoned or in which the proceedings were terminated and which application is referenced by either a published application, an application open to public inspection or an issued patent A record from this system of records may be disclosed, as a routine use, to a Federal, State, or local law enforcement agency, if the USPTO becomes aware of a violation or potential violation of law or regulation.




Semiconductor




filed on


Hiram Stein Residence (except for a deceased or legally incapacitated inventor):

City


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[Page 1 of 2]




D D D Ill



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PERSON EXECUTING THIS SUBSTITUTE STATEMENT:

Name:

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Signature:

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EFS W eb 2.2.5




Semiconductor

Representative Information: Representative information should be provided for all practitioners having a power of attorney in the application. Providing this information in the Application Data Sheet does not constitute a power of attorney in the application (see 37 CFR 1.32). Either enter Customer Number or complete the Representative Name section below. If both sections are completed the customer Number will be used for the Representative Information during processing.


• I

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Domestic Benefit/National Stage Information: This section allows for the applicant to either claim benefit under 35 U.S. C. 119(e), 120, 121, or 365(c) or indicate National Stage entry from a PCT application. Providing this information in the application data sheet constitutes the specific reference required by 35 U.S.C. 119(e) or 120, and 37 CFR 1.78. Prior Application Status Application Number

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Foreign Priority Information: This section allows for the applicant to claim benefit of foreign priority and to identify any prior foreign application for which priority is not claimed . Providing this informati on in th e application data sheet constitutes th e claim for priority as required by 35 U.S. C. 11 9(b) and 37 CFR 1.55(a).

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EFS Web 2.2.5

Priority Claimed

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If checked, the undersigned hereby grants the USPTO authority to provide the European Patent Office (EPO), the Japan Patent Office (JPO), the Korean Intellectual Property Office (KIPO), the World Intellectual Property Office (WI PO), and any other intellectual property offices in which a foreign application claiming priority to the instant patent application is filed access to the instant patent application. See 37 CFR 1.14(c) and (h). This box should not be checked if the applicant does not wish the EPO, JPO, KIPO, WI PO, or other intellectual property office in which a foreign application claiming priority to the instant patent application is filed to have access to the instant patent application. In accordance with 37 CFR 1.14(h) (3), access will be provided to a copy of the instant patent application with respect to: 1) the instant patent application-as-filed; 2) any foreign application to which the instant patent application claims priority under 35 U.S. C. 119(a)-(d) if a copy of the foreign application that satisfies the certified copy requirement of 37 CFR 1.55 has been filed in the instant patent application; and 3) any U.S. application-as-filed from which benefit is sought in the instant patent application. In accordance with 37 CFR 1.14(c), access may be provided to information concerning the date of filing this Authorization.


Applicant

1

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If the applicant is the inventor (or the remaining joint inventor or inventors under 37 CFR 1.45), this section should not be completed. The information to be provided in this section is the name and address of the legal representative who is the applicant under 37 CFR 1.43; or the name and address of the assignee, person to whom the inventor is under an obligation to assign the invention, or person who otherwise shows sufficient proprietary interest in the matter who is the applicant under 37 CFR 1.46. If the applicant is an applicant under 37 CFR 1.46 (assignee, person to whom the inventor is obligated to assign, or person who otherwise shows sufficient proprietary interest) together with one or more joint inventors, then the joint inventor or inventors who are also the applicant should be identified in this section.

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2.


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A record in this system of records may be disclosed , as a routine use, to a Member of Congress submitting a request involving an individu al, to whom th e record pertains , wh en th e individual has requested assi stance from th e Member with respect to th e subj ect matter of the record.

4.

A record in this system of rec ords may be disclosed, as a routine use, to a contractor of the Agency having need for th e information in order to perform a contract. Recipients of information shall be required to comply with the requirements of the Privacy Act of 1974, as amended, pursuant to 5 U.S.C. 552a(m).

5.

A record related to an International Application filed under the Patent Cooperation Treaty in this system of records may be disclosed, as a routine use , to the International Bureau of the World Intellectu al Property Organization, pursuant to th e Patent Cooperation Treaty.

6.

A record in this system of records may be disclosed , as a routine use, to another federal agency for purposes of National Security review (35 U. S.C. 181) and for review pursuant to th e Atomic Energy Act (42 U.S.C. 218(c)).

7.

A record from this system of records may be disclosed, as a routine use, to the Administrator, General Services, or his/her designee, during an inspection of records conducted by GSA as part of that agency's re sponsibility to recommend improvements in records managem ent practices and programs , under authority of 44 U.S. C. 2904 and 2906. Such di sclosure shall be made in accordance with th e GSA regulations governing inspection of records for this purpose , and any other relevant (i.e., GSA or Commerce) directive. Such di sclosure shall not be used to make det erminations about individuals.

8.

A record from this system of records may be disclosed, as a routine use, to the public after either publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent pursuant to 35 U.S.C. 151. Further , a record may be disclosed, subj ect to the limitations of 37 CFR 1.14, as a routin e use, to th e public if th e record was fil ed in an appli cation which becam e abandon ed or in which th e proceedings were terminated and which application is referenced by either a published application , an application open to public inspections or an issued patent.

9.

A record from this system of records may be disclosed, as a routine use, to a Federal , state , or local law enforcement agency, if the USPTO becomes aware of a violation or potential violation of law or regulation.

EFS W eb 2.2.5

Example 3 Corporate Assignee as Applicant

FACTS: Inventors: Adam Smith, Matthew Jones, and Hiram Stein. All three inventors assigned the invention to XZY Corporation. Applicant: XYZ Corporation, the assignee Is a patent practitioner representing the Applicant? Yes, XYZ Corporation is a juristic entity and must be represented by a patent practitioner.

RECOMMENDED INVENTOR’S OATH/DECLARATION FORMS: Inventor’s Oath or Declaration Submit one Form AIA/01 (Declaration for Utility or Design Application Using an Application Data Sheet (37 CFR 1.76)) identifying and signed by each inventor (i.e., three forms total). The declaration forms may be submitted with the application (recommended to avoid payment of a surcharge) or may be submitted together or serially during prosecution until required by the USPTO. ADS (Form AIA/14) •

In the Inventor Information section, print or list the legal name, residence, and mailing address for all three inventors.

•

In the Applicant Information section, print or type XYZ Corporation and select the “Assignee” radio button. An ADS must be filed in accordance with 37 CFR 1.46 since XYZ Corporation is being named as the applicant.

•

A patent practitioner must sign the ADS on behalf of the corporate juristic entity. XYZ Corporation may give power of attorney to the patent practitioner using Form AIA/82 (Transmittal for Power of Attorney to One or More Registered Practitioners and Power of Attorney by Applicant) without need to comply with 37 CFR 3.71 and 3.73.



Compound A


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Inventor:

Date (Optional) :_1_1_13 _0 _1_1_2_____

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The attached application, or

D

United States application or PCT international application number __________ filed on _ _ _ _ _ _ _ _ _ _ _ _ _ __



I hereby acknowledge that any willful false statement made in this declaration is punishable under 18 U.S.C. 1001 by fine or imprisonment of not more than five (5) years, or both.

WARNING: Petitioner/applicant is cautioned to avoid submitting personal information in documents filed in a patent application that may contribute to identity theft. Personal information such as social security numbers, bank account numbers, or credit card numbers (other than a check or credit card authorization form PT0-2038 submitted for payment purposes) is never required by the USPTO to support a petition or an application. If this type of personal information is included in documents submitted to the USPTO, petitioners/applicants should consider redacting such personal information from th e documents before submitting them to the USPTO. Petitioner/applicant is advised that the record of a patent application is available to the public after publication of the application (unless a non-publication request in compliance with 37 CFR 1.213(a) is made in the application) or issuance of a patent. Furthermore, the record from an abandoned application may also be available to the public if the application is referenced in a published application or an issued patent (see 37 CFR 1.14). Checks and cred it card a uthorization forms PT0-2038 submitted for payment purposes are not retained in the application file and therefore are not publicly available.


Inventor:

Matthew Jones

Signature: /Matthew

Date (Optional) :_1_2_10 _3 _1_1_2_ _ _ __

Jones/

Note: An application data sheet (PTO/SB/14 or equivalent), including naming the entire inventive entity, must accompany this form or must have been previously filed. Use an additional PTO/AIA/01 form for each additional inventor. This collection of information is required by 35 U.S.C. 115 and 37 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 process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. Thi s collection is estimated to take 1 minute to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any comments on the amount oftime you require to complete this form and/or suggestions for reducing this burden , should be sent to the Ch ief Information Officer, U.S. Patent and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 223 13-1450. DO NOT SEND FEES OR COMP LETED FORMS TO THIS ADDRESS . SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450. If you ne ed assistance in comple ting the form, ca/11-800-PT0 -9199 and select option 2.


2.

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7.

8.

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Inventor:

10 _1_1_2_____ Date (Optional) :_1_2_1_

Hiram Stein

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2.

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Representative Information: Representative information should be provided for all practitioners having a power of attorney in the application. Providing this information in the Application Data Sheet does not constitute a power of attorney in the application (see 37 CFR 1.32) . Either enter Customer Number or complete the Representative Name section below. If both section s are completed the customer Number will be used for the Representative Information during processing .

EFS Web 2.2.5




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Domestic Benefit/National Stage Information: This section allows for the applicant to either claim benefit under 35 U. S.C. 119(e), 120, 121 , or 365(c) or indicate National Stage entry from a PCT application. Providing this information in the application data sheet constitutes the specific reference required by 35 U.S.C. 119(e) or 120, and 37 CFR 1.78. Prior Application Status

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. Signature·.

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NOTE: This form must be signed in accordance with 37 CFR 1.33. See 37 CFR 1.4 for signature requirements and certifications Signature First Name

IVJohn Q . Practition er/

~ohn

I

Last Name [ [Practitioner

Date (YYYY-MM-DD)

~01 2-1 3-1 2

Registration Number

~8765


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XYZ.0427

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Example 4 Corporate Assignee as Application with Substitute Statements Needed

FACTS: Inventors: Matthew Jones, Mary Williams, and Hiram Stein. All three inventors assigned the invention to XYZ Corporation. Mary Williams is deceased, and Hiram Stein has refused to sign the declaration. Applicant: XYZ Corporation, the assignee Is a patent practitioner representing the Applicant? Yes, XYZ Corporation is a juristic entity and must be represented by a patent practitioner.

RECOMMENDED INVENTOR’S OATH/DECLARATION FORMS: Inventor’s Oath or Declaration •

Submit one Form AIA/01 (Declaration for Utility or Design Application Using an Application Data Sheet (37 CFR 1.76)) identifying and signed by Matthew Jones.

•

Submit one Form AIA/02 (Substitute Statement in Lieu of an Oath or Declaration for Utility or Design Patent Application (35 U.S.C. 115(d) and 37 CFR 1.64)) signed by XYZ Corporation on behalf of non-signing inventor Hiram Stein. Since an ADS is being submitted, it is not necessary to list the residence and mailing address for Hiram Stein.

•

Submit one Form AIA/02 (Substitute Statement in Lieu of an Oath or Declaration for Utility or Design Patent Application (35 U.S.C. 115(d) and 37 CFR 1.64)) signed by XYZ Corporation on behalf of deceased inventor Mary Williams. A legal representative is not required to sign on behalf of the deceased inventor in this instance.

•

The substitute statements must be signed by someone who is authorized to act on behalf of the assignee-applicant (i.e., a person with a title that carries apparent authority, or a person who includes a statement of authorization to act.). A patent practitioner is not authorized to act on behalf of an applicant simply by existence of authority to prosecute an application. However, where an applicant gives the practitioner specific authority to act (e.g., authority given by organizational resolution), a practitioner may sign the substitute statement on behalf of the applicant.

•

The forms may be submitted with the application (recommended to avoid payment of a surcharge) or may be submitted together or serially during prosecution until required by the USPTO.

ADS (Form AIA/14) •

In the Inventor Information section, print or type the legal name for all three inventors, and residence and mailing address for Matthew Jones and Hiram Stein. The residence and mailing address are not required for Mary Williams since she is deceased.

•

In the Applicant Information section, print or type XYZ Corporation and select the “Assignee” radio button. An ADS must be filed in accordance with 37 CFR 1.46 since XYZ Corporation is being named as the applicant.

•

A patent practitioner must sign the ADS on behalf of the corporate juristic entity. XYZ Corporation may give power of attorney to the patent practitioner using Form AIA/82 (Transmittal for Power of Attorney to One or More Registered Practitioners and Power of Attorney by Applicant) without need to comply with 37 CFR 3.71 and 3.73.



Data Processing System


Ill D







Inventor:

Matthew Jones

Signature: /Matthew

Date (Optional) :_1_2_10 _3 _1_1_2_ _ _ __

Jones/



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PTO/AI.AJ02 (06-12) Approved for use through 01/31/2014. 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 displays a valid OMB control number.






filed on


Mary Williams Residence (except for a deceased or legally incapacitated inventor):

City

State Mailing Address (except for a deceased or legally incapacitated inventor):

rity

State

Countrv

Zio

Country

I believe the above-named inventor or joint inventor to be the original inventor or an original joint inventor of a claimed invention in the application.


I hereby acknowledge that any willful false statement made in this statement is punishable under 18 U.S. C . 1001 by fine or imprisonment of not more than five (5) years, or both.

Relationship to the inventor to whom this substitute statement applies:

D

•

Legal Representative (for deceased or legally incapacitated inventor only), Assignee,

D Person to whom the inventor is under an obligation to assign , D Person who otherwise shows a sufficient proprietary interest in the matter (petition under 37 CFR 1.46 is required), or D Joint Inventor. [Page 1 of 2]

This collection of information is required by 35 U. S.C. 115 and 37 CFR 1.63. The information is r equired t o obtain or retain a b enefit 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 estimated to take 1 minute to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any comments on th e amount oftime you require t o complete this form and/or suggestions for reducing this burden , should be sent to the Chief Information Officer, U.S. Patent and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandri a, VA 223 13-1450. DO NOT SEND FEES OR COMPLETED FORM S TO THIS ADDRESS . SEND TO: Commissioner for Patents, P.O. Box 1450, Al exandria, VA 2231 3-1450. If you need assistance in comple ting the form, ca/11-800-PT0-9199 and select option 2.



Ill D D D



D


WARNING: Petitioner/applicant is cautioned to avoid submitting personal information in documents filed in a patent application that may contribute to identity theft. Personal information such as social security numbers, bank account numbers, or credit card numbers (other than a check or credit card authorization form PT0-2038 submitted for payment purposes) is never required by the USPTO to support a petition or an application. If th is type of personal information is included in documents submitted to the USPTO, petition ers/applicants should consider redacting such personal information from th e documents before submitting them to the USPTO. Petitioner/applicant is advised that the record of a patent application is available to the public after publication of th e application (unless a non-publication request in compliance with 37 C FR 1.213(a) is made in the application) or issuance of a patent. Furthermore, th e record from an abandoned application may also be available to the public if the application is referenced in a published application or an issued patent (see 37 CFR 1.14). Checks and cred it ca rd authorization forms PT0-2038 submitted for payment purposes are not retained in the application file and therefore are not publicly available.

PERSON EXECUTING THIS SUBSTITUTE STATEMENT: Name:

John Taylor (President, XYZ Corporation)

Signature:

12/03/12 Date (Optional):

/John Taylor/


City

DE

Dover

Country State Mailing Address (unless provided in an application data sheet, PTO/AIA/14 or equivalent)

USA

123 Main Street

City

Dover

State

DE

Zip

12345

Country

USA

Note: Use an additional PTO/AIN02 form for each inventor who is deceased , legally incapacitated, cannot be found or reached after diligent effort, or has refused to execute the oath or declaration under 37 CFR 1.63. [Page 2 of 2]


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Hiram Stein Residence (except for a deceased or legally incapacitated inventor):

City


r ity

State

Countrv

Zio

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D

•

Legal Rep resentative (for deceased or legally incapacitated inventor only) , Assignee,

D Person to whom the inventor is under an obligation to assign, D Person who otherwise shows a sufficient proprietary interest in the matter (petition under 37 C FR 1.46 is required), or D Joint Inventor. [Page 1 of 2]




D D D Ill



D



PERSON EXECUTING THIS SUBSTITUTE STATEMENT: Name:

John Taylor (President, XYZ Corporation)

Signature:

12/03/12 Date (Optional):

/John Taylor/


City

DE

Dover

Country State Mailing Address (unless provided in an application data sheet, PTO/AIA/14 or equivalent)

USA

123 Main Street

City

Dover

State

DE

Zip

12345

Country

USA



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324XYZ 5478

Application Number




D

Portions or all of the application associated with this Application Data Sheet may fall under a Secrecy Order pursuant to 37 CFR 5.2 (Paper filers only. Applications that fall under Secrecy Order may not be fi led electronically.)



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Attorney Docket Number 324XYZ 5478


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Publication Information:

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Request Early Publicati on (Fee requi red at time of Request 37 CFR 1.21 9)

0

Request Not to Publish. I hereby re quest that the attached applicati on not be published under 35 U.S. C. 122( b) and certify that the invention disclosed in the attached applicatio n has not and will not be the s ubject of an applicati on filed in another country, or under a multilateral internati onal agreement, that req uires publication at eighteen months after filing.

Representative Information: Representative information should be provided for all practitioners having a power of attorney in the application. Providing this information in the Application Data Sheet does not constitute a power of attorney in the application (see 37 CFR 1.32) . Either enter Customer Number or complete the Representative Name section below. If both sections are completed the customer Number will be used fo r the Representative Info rmation during processing.

EFS W eb 2.2.5



324XYZ 5478

Application Number


Please Select One:

j

Customer Number

Prefix

Given Name

jMr.

~ohn

l·


Registration Number

1

~8765

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Additional Representative Information blocks may be generated within this form by selecting the Add button.

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Domestic Benefit/National Stage Information: This section allows for the applicant to either claim benefit under 35 U.S. C. 119(e), 120, 121, or 365(c) or indicate National Stage entry from a PCT application. Providing this information in the application data sheet constitutes the specific reference required by 35 U.S.C. 119(e) or 120, and 37 CFR 1.78. Prior Application Status Application Number

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Additional Domestic Benefit/National Stage Data may be generated w ithin this form by selecting the Add button .

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Foreign Priority Information: This section allows for the applicant to claim benefit of foreign priority and to identify any prior foreign application for which priority is not claimed . Providing this informati on in th e application data sheet constitutes th e claim for priority as required by 35 U.S. C. 11 9(b) and 37 CFR 1.55(a).

I Remove I Applicati on Number

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Filing Date (YYYY-M M-DD)

Country'

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Additional Foreign P riority Data may be gene rated within this form by selecting the

Add button.

Authorization to Permit Access: Authorization to Permit Access to the Instant Application by the Parti cipating Offices

EFS Web 2.2.5

Priority Claimed

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Yes

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No




324XYZ 5478

Application Number




Applicant

1

If the applicant is th e inve ntor (or the remai ning joint inventor or inve ntors under 37 CFR 1.45), this section should not be completed. The information to be provided in thi s section is the name and address of the legal representative who is the applicant under 37 CFR 1.43; or th e name and address of the assignee, person to whom th e inventor is under an obligation to assign the invention, or person who otherwise shows sufficie nt proprietary interest in th e matter who is the applicant under 37 CFR 1.46. If the applicant is an applicant under 37 CFR 1.46 (assignee, person to whom the inventor is obligated to assign, or person who otherwise shows sufficie nt proprietary interest) togeth er with one or more joint inventors, then the joint inve ntor or inventors who are also th e applicant should be identified in this section.

I Remove I

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l"'J Name of the Deceased or Legally Incapacitated Inventor If the Applicant is an Organization check here. Orga nization Name

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I ~YZ Corporation


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324XYZ 5478

Application Number


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1


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BI

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If the Assignee is an Organizatio n check here. Prefix

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Middle Name

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Suffix

I

I

I

B


II

City Countryi

State/Province

II

Postal Code

Phone Numbe r

Fax Number

Email Address Additional Ass ignee Data may be generated within thi s form by selecting the Add button.

Add

I

Remove

I

I

. Signature·.

I

NOTE: This form must be signed in accordance with 37 CFR 1.33. See 37 CFR 1.4 for signature requirements and certificati ons

Signature First Name

IVJohn Q . Practition er/

~ohn

I

Last Name

[ [Practitioner

Date (YYYY-MM-DD)

~01 2-1 3-1 2

Registration Number

~8765


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324XYZ 5478

Application Number



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