ࡱ> q` bjbjqPqP ::+a( ( ( ( ( ( ( Dl 000t1d1l qaHx3h5(5554=N>>LWWWW/&X<b\<`$bh!ej`i( F|<|< F F`( ( 55+aKKK F( 5( 5WK FWKKO( ( P 5l3 @Tqf&u0FOyQ|Aa0qaPf|Gf4)Pf( )PP.?r@KA|B.?.?.?``K.?.?.?qa F F F Fl l l $p/l l l p/l l l ( ( ( ( ( (  PTO/SB/01 (06-07) Approved for use through 06/30/2010. 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 FOR UTILITY OR DESIGN PATENT APPLICATION (37 CFR 1.63) Attorney Docket Number(for our use only)First Named InventorJANE DOECOMPLETE IF KNOWNApplication NumberTBA FORMCHECKBOX  Declaration Submitted With Initial Filing  OR FORMCHECKBOX  Declaration Submitted after Initial Filing (surcharge (37 CFR 1.16 (f)) required) Filing DateHerewithGroup Art UnitTBAExaminer NameTBAI hereby declare that: (1) Each inventors residence, mailing address, and citizenship are as stated below next to their name; and (2) I believe the inventor(s) names 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:APPARATUS AND METHOD FOR MAKING XYZ(Title of the Invention)the specification of which  FORMCHECKBOX  is attached hereto OR FORMCHECKBOX  was filed on (MM/DD/YYYY) FORMTEXT      As United States Application Number or PCT InternationalApplication Number FORMTEXT      and was amended on (MM/DD/YYYY) FORMTEXT      (if applicable).I hereby state that I have reviewed and understand the contents of the above identified application, including the claims, as amended by any amendment specifically referred to above. 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[Page 1 of 3] DECLARATION Utility or Design Patent Application   Claim of Foreign Priority Benefits I hereby claim foreign priority benefits under 35 U.S.C. 119(a)-(d) or (f), or 365(b) of any foreign application(s) for patent, inventors or plant breeders rights certificate(s), or 365(a) of any PCT international application which designated at least one country other than the United States of America, listed below and have also identified below, by checking the box, any foreign application for patent, inventors or plant breeders rights certificate(s), or any PCT international application having a filing date before that of the application on which priority is claimed.Prior Foreign Application Number(s)CountryForeign Filing Date (MM/DD/YYYY)Priority Not ClaimedCertified Copy Attached? 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I hereby declare that all statements made herein of my own knowledge are true and that all statements made on information and belief are believed to be true; and further that these statements were made with the knowledge that willful false statements and the like so made are punishable by fine or imprisonment, or both, under 18 U.S.C. 1001 and that such willful false statements may jeopardize the validity of the application or any patent issued thereon.NAME OF SOLE OR FIRST INVENTOR : FORMCHECKBOX  A petition has been filed for this unsigned inventorGiven Name (first and middle [if any]) JANEFamily Name or Surname DOEInventors SignatureDate mm/dd/yyyyResidence: City Any CityState Any stateCountry U.S.Citizenship United States of AmericaMailing Address 123456 Any StreetCity Any CityState Any stateZIP 09876Country U.S. FORMCHECKBOX  Additional inventors or a legal representative are being named on the ___________ supplemental sheet(s) PTO/SB/02A or 02LR attached hereto.[Page 3 of 3]       PAGE 2  FILENAME \* MERGEFORMAT Sample Declaration (filled in)  This collection of information is required by 35 U.S.C. 115 and 37 CFR 1.63. 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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. $<a$< 00&P/R :p+j/ =!@"@#$ %@ ? 0 00&P/R :p+j/ =!@"@#$ %` < 00&P/R :p+j/ =!@"@#$ %` < 00&P/R :p+j/ =!@"@#$ % $$If!vh5v5 5 #vv#v #v :V l40      ,,5v5 5 4f4$$If!vh5v5 5 #vv#v #v :V l40      +,,5v5 5 4f4$$If!vh5v5 5 #vv#v #v :V l40      +,5v5 5 4f4$$If!vh5v5#vv#v:V l40      +,5v5/ 4f4$$If!vh5v5b50#vv#vb#v0:V l4_0      +,5v5b50/ / 4f4tDeCheck1tDeCheck17$$If!vh555$ 5b50#v#v#v$ #vb#v0:V l40      +++,555$ 5b50/  / / / / 4f47$$If!vh555$ 5b50#v#v#v$ #vb#v0:V l40      +++,555$ 5b50/  / / / / 4f47$$If!vh555$ 5b50#v#v#v$ #vb#v0:V l4\0      +++,555$ 5b50/  / / / / 4f4$$If!vh5 5(5#v #v(#v:V l40    5 5(5/ 4f4$$If!vh5 5(5#v #v(#v:V l40    5 5(5/ / / 4f4$$If!vh5 5(5#v #v(#v:V l40    5 5(5/ 4f4hDe$$If!vh5 5(5#v #v(#v:V l40    5 5(54f4tDeCheck1tDText9 $$If!vh5 5N 5Q 5]5#v #vN #vQ #v]#v:V l40    ,5 5N 5Q 5]5/ / / 4f4$$If!vh5 5(5#v #v(#v:V l40    5 5(54f4vDText10vDText11T$$If!vh5 555 55z5#v #v#v#v #v#vz#v:V l4 0    ,5 555 55z5/ / /  / / 4f4$$If!vh5 5(5#v #v(#v:V l40    5 5(54f4$$If!vh5 5(5#v #v(#v:V l40    5 5(54f4$$If!vh5 5(5#v #v(#v:V l40    5 5(5/ 4f4tDeCheck1$$If!vh5 5(5#v #v(#v:V l40    5 5(5/ /  4f4Dd (# z  S 0ABD10289_S"ob:64\_1QO:I n:64\_1QO:PNG  IHDRX ȚsRGBPLTE+ס cmPPJCmp0712ubtRNS@f"IDAT8c````Y΢ `:k4m }gSfe૰IENDB`$$If!vh5 5(5#v #v(#v:V l40    5 5(5/ /  /  / 4f4U$$If!vh5*#v*:V!l t65*/  $$If!vh5 5(5#v #v(#v:V l40    5 5(5/  / 4f4$$If!vh5 5(5#v #v(#v:V l40    5 5(5/ 4f4$$If!vh5 5(5#v #v(#v:V l40    5 5(5/  / 4f4X$$If!vh5 5 55D55) 5#v #v #v#vD#v#v) #v:V l40    5 5 55D55) 5/ / / / / / 4f4tDeCheck8tDeCheck3tDeCheck3|$$If!vh5 5 55D55655#v #v #v#vD#v#v6#v#v:V l40    5 5 55D55655/  / /  / / / / 4f4vDText35vDText35vDText35tDeCheck8tDeCheck8tDeCheck8|$$If!vh5 5 55D55655#v #v #v#vD#v#v6#v#v:V l40    5 5 55D55655/  / /  / / / / 4f4vDText38vDText39vDText40tDeCheck3tDeCheck3tDeCheck3|$$If!vh5 5 55D55655#v #v #v#vD#v#v6#v#v:V l40    5 5 55D55655/  / /  / / / / 4f4vDText41vDText42vDText43tDeCheck3tDeCheck3tDeCheck3$$If!vh5 5 55D55655#v #v #v#vD#v#v6#v#v:V l40    5 5 55D55655/  / /  / / / / / 4f4tDeCheck2$$If!vh5*5#v*#v:V l40    5*5/ /  4f4$$If!vh5+#v+:V lj0    5+/ 4$$If!vh5+#v+:V l>0    ,5+/ /  4tDeCheck4tDCheck5 $$If!vh5R 555#vR #v#v#v:V l0    ,5R 555/  / / / / 4$$If!vh5+#v+:V l40    5+/ / 4f4Df Dropdown1 Grant D. 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