Form PTO/SB/AIA09 Plant Patent Application (35 U.S.C. 161) Declaration (37

Doc Code: Oath
Document
Description: Oath or declaration filed
Doc Code:

___

PTO/SB/AIA09 (06-12)
Approved for use through 01/31/2014. 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.

PLANT PATENT

APPLICATION (35 U.S.C. 161)

DECLARATION

(37 CFR 1.)

Declaration
Submitted
with Initial
Filing

OR

Declaration
Submitted after Initial
Filing (surcharge
(37 CFR 1.16(e))
required)

Attorney Docket Number
First Named Inventor
COMPLETE IF KNOWN
Application Number
Filing Date
Art Unit
Examiner Name

The new and distinct variety of:

plant named:

As a below named inventor, I hereby declare that:
This declaration is directed to:
The attached application
OR

Residence: City
United States Application Number ____________________ filed on (MM/DD/YYYY) ____________________________ .

I have asexually reproduced the plant to which this application applies.

Said plant was found in cultivated area (check this box for newly found plant only)
The above-identified application was made or authorized to be made by me.
I believe I am the original inventor or an original joint inventor of a claimed invention in the application.
I hereby acknowledge that any willful false statement made in this declaration is punishable under 18 U.S.C. 1001
by fine or imprisonment of not more than five (5) years, or both.

[Page 1 of 2]
This collection of information is required by 35 U.S.C. 115 and 37 CFR 1.63. 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 21
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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.

PTO/SB/AIA09 (06-12)
Approved for use through 01/31/2014. 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.

Doc Code:

DECLARATION - Plant Patent Application
Direct all correspondence to:
OR

The address associated with Customer Number:
Correspondence address below

Name
Address

City

State

Country

Zip

Telephone

Email

WARNING:
Petitioner/applicant is cautioned to avoid submitting personal information in documents filed in a patent application that may
contribute to identity theft. Personal information such as social security numbers, bank account numbers, or credit card
numbers (other than a check or credit card authorization form PTO-2038 submitted for payment purposes) is never required by
the USPTO to support a petition or an application. If this type of personal information is included in documents submitted to the
USPTO, petitioners/applicants should consider redacting such personal information from the documents before submitting them
to the USPTO. Petitioner/applicant is advised that the record of a patent application is available to the public after publication of
the application (unless a non-publication request in compliance with 37 CFR 1.213(a) is made in the application) or issuance of
a patent. Furthermore, the record from an abandoned application may also be available to the public if the application is
referenced in a published application or an issued patent (see 37 CFR 1.14). Checks and credit card authorization forms PTO­
2038 submitted for payment purposes are not retained in the application file and therefore are not publicly available.

LEGAL NAME OF SOLE OR FIRST INVENTOR:
((J Given Name (first and middle (if any) and Family Name or Surname)
Inventor's Signature

Date (Optional)
State

Residence: City

Country

Mailing Address

City

State

Zip

Country

Additional inventors are being named on the_____ supplemental sheet(s) PTO/SB/AIA10 attached hereto
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