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Supplemental Declaration For Amendments



SUPPLEMENTAL DECLARATION FOR AMENDMENTS

State of [State]
County of [County]

I, [Name of inventor], the inventor of an improvement in [Description of the Invention], having filed an application for a patent in the United States Patent and Trademark Office on [Date], declare that the subject matter of the foregoing amendment was part of my invention and was invented before the filing of the original application. To the best of my knowledge and belief, this invention was never known or used in the United States before my invention of it nor was it patented or offered for sale prior to that time.

To the best of my knowledge and belief, all the statements made herein are true and were made with the knowledge that willful false statements are unlawful and punishable by fine or imprisonment or both.



Signature Date