Form PTO/SB/51S Supplemental Declaration for Reissue Patent Application

Doc Code:

PTO/SB/51S (09-07)
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 contains a valid OMB control number.

SUPPLEMENTAL DECLARATION

FOR REISSUE

PATENT APPLICATION

TO CORRECT “ERRORS” STATEMENT
(37 CFR 1.175)

Attorney Docket Number
First Named Inventor

COMPLETE if known
Application Number
Filing Date
Art Unit
Examiner Name

I/We hereby declare that:
Every error in the patent which was corrected in the present reissue application, and which is not covered by the
prior oath(s) and/or declaration(s) submitted in this application, arose without any deceptive intention on the part of
the applicant.

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/We hereby declare that all statements made herein of my/our 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 issued
thereon.
Name of Sole or First Inventor:
Given Name (first and middle [if any])

A petition has been filed for this unsigned inventor
Family Name or Surname

Inventor’s
Signature

Date

Name of Second Inventor:
Given Name (first and middle [if any])

Inventor’s
Signature

A petition has been filed for this unsigned inventor
Family Name or Surname

Date

Additional inventors or legal representatives(s) are being named on the __________ supplemental sheets PTO/SB/02A or 02LR attached hereto.
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 valid
OMB Control Number. The OMB Control Number for this information collection is 0651-0033. Public burden for this form is estimated to average 36
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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 Office of the Chief Administrative Officer, United States Patent and Trademark Office,
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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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abandonment of the application or expiration of the patent.
The information provided by you in this form will be subject to the following routine uses:
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