PTO/SB/01 Declaration for Utility or Design Application (37 CFR 1.

Doc Code: Oath
Document Description: Oath or declaration filed

PTO/SB/01 (04-19)
Approved for use through 05/31/2024. 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 contains a valid OMB control number.

DECLARATION FOR UTILITY OR
DESIGN
PATENT APPLICATION
(37 CFR 1.63)

Attorney Docket
Number
First Named Inventor
COMPLETE IF KNOWN
Application Number

Declaration
Submitted
With Initial
Filing

Declaration
Submitted After Initial
Filing (surcharge
(37 CFR 1.16(f))
required)

OR

Filing Date
Art Unit
Examiner Name

I hereby declare that: (1) Each inventor's residence, mailing address, and citizenship are as stated below next to their name;
and (2) I believe the inventor(s) named below to be the original and first inventor(s) of the subject matter which is claimed and
for which a patent is sought on the invention titled:

(Title of the Invention)
the application of which was made or was authorized to be made by me and
is attached hereto
OR
was filed on (MM/DD/YYYY)
Application Number

as United States Application Number or PCT International
and was amended on (MM/DD/YYYY)

(if applicable).

I hereby state that I have reviewed and understand the contents of the above identified application, including the claims, as
amended by any amendment specifically referred to above.
I hereby acknowledge the duty to disclose information which is material to patentability as defined in 37 CFR 1.56, including for
continuation-in-part applications, material information which became available between the filing date of the prior application and
the national or PCT international filing date of the continuation-in-part application.

Claim of Foreign Priority Benefits
I hereby claim foreign priority benefits under 35 U.S.C. 119(a)-(d) or (f), or 365(b) of any foreign application(s) for patent,
inventor's or plant breeder's rights certificate(s), or 365(a) of any PCT international application which designated at least one
country other than the United States of America, listed below and have also identified below, by checking the box any foreign
application for patent, inventor's or plant breeder's rights certificate(s), or any PCT international application having a filing date
before that of the application on which priority is claimed.
Priority Foreign
Application Number(s)

Country

Foreign Filing Date
(MM/DD/YYYY)

Priority Not Claimed

Certified Copy Attached?
YES
NO

Additional foreign application number(s) are listed on a supplemental priority data sheet PTO/SB/02B attached hereto.

[Page 1 of 2]
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an
information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a currently valid OMB Control
Number. The OMB Control Number for this information collection is 0651-0032. Public burden for this form is estimated to average 21 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this
burden to the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email
InformationCollection@uspto.gov. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. If filing this completed form by mail, 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/01 (04-19)
Approved for use through 05/31/2024. 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 contains a valid OMB control number.

DECLARATION – Utility or Design Patent Application
The address
associated with
Customer Number:

Direct all
correspondence to:
Name

Correspondence
address below

OR

Address
City
Country

State

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.
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 or any patent
issue thereon.
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.

NAME OF SOLE OR FIRST INVENTOR

A petition has been filed for this unsigned inventor

Given Name (first and middle [if any])

Family Name or Surname

Inventor’s Signature
Residence: City

Date
State

Country

Citizenship

Zip

Country

Mailing Address
City

State

Additional inventors or a legal representative are being named on the __________ supplemental sheet(s) PTO/SB/02A or 02LR attached hereto

[Page 2 of 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. The United States Patent
and Trademark Office (USPTO) collects the information in this record under authority of 35 U.S.C. 2.
The USPTO’s system of records is used to manage all applicant and owner information including name,
citizenship, residence, post office address, and other information with respect to inventors and their legal
representatives pertaining to the applicant's/owner’s activities in connection with the invention for which
a patent is sought or has been granted. The applicable Privacy Act System of Records Notice for the
information collected in this form is COMMERCE/PAT-TM-7 Patent Application Files, available in the
Federal Register at 78 FR 19243 (March 29, 2013). https://www.govinfo.gov/content/pkg/
FR-2013-03-29/pdf/2013-07341.pdf
Routine uses of the information in this record may include disclosure to: 1) law enforcement, in the event
that the system of records indicates a violation or potential violation of law; 2) a Federal, state, local, or
international agency, in response to its request; 3) a contractor of the USPTO having need for the
information in order to perform a contract; 4) the Department of Justice for determination of whether the
Freedom of Information Act (FOIA) requires disclosure of the record; 5) a Member of Congress
submitting a request involving an individual to whom the record pertains, when the individual has
requested the Member’s assistance with respect to the subject matter of the record; 6) a court,
magistrate, or administrative tribunal, in the course of presenting evidence, including disclosures to
opposing counsel in the course of settlement negotiations; 7) the Administrator, General Services
Administration (GSA), or their designee, during an inspection of records conducted by GSA under
authority of 44 U.S.C. 2904 and 2906, in accordance with the GSA regulations and any other relevant
(i.e., GSA or Commerce) directive, where such disclosure shall not be used to make determinations
about individuals; 8) another federal agency for purposes of National Security review (35 U.S.C. 181)
and for review pursuant to the Atomic Energy Act (42 U.S.C. 218(c)); 9) the Office of Personnel
Management (OPM) for personnel research purposes; and 9) the Office of Management and Budget
(OMB) for legislative coordination and clearance.
If you do not furnish the information requested on this form, the USPTO may not be able to process and/
or examine your submission, which may result in termination of proceedings, abandonment of the
application, and/or expiration of the patent.

Additional Uses
Additional USPTO uses of the information in this record may include disclosure to: 1) the International
Bureau of the World Intellectual Property Organization, if the record is related to an international
application filed under the Patent Cooperation Treaty; 2) the public i) after publication of the application
pursuant to 35 U.S.C. 122(b), ii) after issuance of a patent pursuant to 35 U.S.C. 151, iii) if the record
was filed in an application which became abandoned or in which the proceedings were terminated and
which application is referenced by either a published application, an application open to public
inspections, or an issued patent, or iv) without publication of the application or patent under the specific
circumstances provided for by 37 CFR 1.14(a)(1)(v)-(vii); and/or 3) the National Archives and Records
Administration, for inspection of records.