PTO/SB/51 Reissue Application Declaration by the Inventor

PTO/SB/51 (09-12)
Approved for use through XX/XX/XXXX. OMB 0651-0033
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.

Docket Number (Optional)

REISSUE APPLICATION DECLARATION BY THE INVENTOR

I hereby declare that:
Each inventor’s residence, mailing address and citizenship are stated below next to their name.
I believe the inventors named below to be the original and first inventor(s) of the subject matter which is described and claimed
in patent number
, granted
and for which a
reissue patent is sought on the invention entitled __________________________________________________________,
,

the specification of which
is attached hereto.
was filed on

as reissue application number

and was amended on

.
(If applicable)

I have reviewed and understand the contents of the above-identified specification, including the claims, as amended by any
amendment referred to above. This application was made or was authorized to be made by me.
I acknowledge the duty to disclose information which is material to patentability as defined in 37 CFR 1.56.
I hereby claim foreign priority benefits under 35 U.S.C. 119(a)-(d) or (f), or 365(b). Attached is form PTO/SB/02B (or
equivalent) listing the foreign applications.
I verily believe the original patent to be wholly or partly inoperative or invalid, for the reasons described
below. (Check all boxes that apply.)
by reason of a defective specification or drawing.
by reason of the patentee claiming more or less than he had the right to claim in the patent.
by reason of other errors.
At least one error upon which reissue is based is described below. If the reissue is a broadening
reissue, such must be stated with an explanation as to the nature of the broadening:

[Page 1 of 2]

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If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

PTO/SB/51 (09-12)

Approved for use through 01/31/2020. OMB 0651-0033

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.

Docket Number (Optional)
(REISSUE APPLICATION DECLARATION BY THE INVENTOR, page 2)
All errors corrected in this reissue application arose without any deceptive intention on the part of the applicant.

Note: To appoint a power of attorney, use form PTO/SB/81.

Correspondence Address: Direct all communications about the application to:

The address associated with Customer Number:

OR
Firm or
Individual Name
Address

City

State

Zip

Country
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.
I hereby declare that all statements made herein of my own knowledge are true and that all statements made on information
and belief are believed to be true; and further that these statements were made with the knowledge that willful false
statements and the like so made are punishable by fine or imprisonment, or both, under 18 U.S.C. 1001, and that such willful
false statements may jeopardize the validity of the application, any patent issuing thereon, or any patent to which this
declaration is directed. I hereby acknowledge that any willful false statement made in this declaration is punishable under 18
35 U.S.C. 1001 by fine or imprisonment of not more than five (5) years, or both.
Full name of sole or first inventor (given name, family name)
Inventor's signature

Date

Residence

Citizenship

Mailing Address

Full name of second joint inventor (given name, family name)
Inventor's signature

Date

Residence

Citizenship

Mailing Address

Additional joint inventors or legal representative(s) are named on separately numbered sheets forms PTO/SB/02A or 02LR attached hereto.

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