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Declaration For Patent Application
DECLARATION FOR PATENT APPLICATION
State of [State]
County of [County]
My name, address, citizenship, and residence are as follows:
Full name of inventor: [Full Name of inventor]
Citizenship: [Citizenship of inventor]
Residence: [Residence of inventor]
Full name of second joint inventor, if any:
Full name of inventor: [Full Name of second inventor]
Citizenship: [Citizenship of second inventor]
Residence: [Residence of second inventor]
I am [the sole inventor or a joint inventor] of the subject matter for which I am seeking a patent. The specification is attached hereto, or was filed on [Date filed ] as application number [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 inventors certificate which is listed below. I have also listed below any foreign application for a patent or inventors 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? [Priority Claimed? Yes/No]
[Number]
[Country]
[Month/Day/Year filed]
Priority Claimed? [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):
U.S. Applications:
[Application Serial Number.]
[Date Filed]
Status: [patented, pending, abandoned]
[Application Serial Number.]
[Date Filed]
Status: [patented, pending, abandoned]
I appoint [Name of attorney] 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]
[Correspondence 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(s) Date