PTO/SB/63 Terminal Disclaimer to Accompany Petition

Doc Code:

PTO/SB/63 (07-09)
Approved for use through 07/31/2012. OMB 0651-0031
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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TERMINAL DISCLAIMER TO ACCOMPANY PETITION

Docket Number (Optional)

In re Application of:
Name:
Application Number:
Filed:
For:

The owner*, ______________________ of _________ percent interest in the above-identified application hereby
disclaims a terminal part of the term of any patent granted the above-identified application equivalent to: (1) if the
above-identified application is a design application, the period of abandonment of the above-identified application,
and (2) if the abov e-identified applic ation is a uti lity or plant appl ication, the less er of: (a) the period of
abandonment of the application; or ( b) the per iod ex tending bey ond twenty years from the date on which the
above-identified application was filed in the United States or, if the appl ication contains a specific reference to an
earlier filed application(s) und er 35 U.S.C. 120, 121, or 365(c), from the date on which the earliest s uch
application was filed. This disclaimer also applies to any patent granted on a utility or plant application filed before
June 8, 199 5, or a des ign application, that conta ins a specific reference under 35 U.S.C. 120, 121, or 365(c) to
the above-identified application. This disclaimer is binding upon the grantee, and its successors or assigns.
Check either box 1 or 2 below, if appropriate.
1.

For submissions on behalf of an organization (e.g., corporation, partnership, university, government
agency, etc.), the undersigned is empowered to act on behalf of the organization.

2.

The undersigned is an attorney or agent of record. Registration Number_______________________.
_______________________________________________________
Signature

_________________________
Date

_______________________________________________________
Typed or Printed Name

_________________________
Telephone Number

Terminal disclaimer fee under 37 CFR 1.20(d) included.
WARNING: Information on this form may become public. Credit card information should not be
included on this form. Provide credit card information and authorization on PTO-2038.
* Statement under 37 CFR 3.73(b) is required if terminal disclaimer is signed by the assignee (owner).

Form PTO/SB/96 may be used for making this certification. See MPEP § 324.

This collection of information is required by 37 CFR 1.137. 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 12 minutes 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 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 Off ice, U.S. Department of Commerce, P.O. Box 1450, Ale xandria, VA 22313- 1450. DO NOT SE ND FEES OR CO MPLETED 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, call 1-800-PTO-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,
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