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Oath--Loss Of Letters Patent
OATH--LOSS OF LETTERS PATENT
State of [State]
County of [County]
I, [Name of Inventor], being duly sworn, depose and say that letters patent No. , which was granted to me on [Date], has either been lost or destroyed. I have made a diligent search for the letters patent everywhere it would probably be found, if it existed, and I have not been able to find it.
Full name of inventor: [Name of Inventor]
Citizenship: [Citizenship of Inventor]
Residence: [Residence of Inventor]
Post Office Address: [Post office address of Inventor]
Signature Date