Form PTO/AIA/50 Reissue Patent Application Transmittal

PTO/AIA/50  (10‐17) 
Approved  for  use  through  XX/XX/XXXX. OMB 0651‐0033 
U.S.  Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE 
  of
  1995

  persons

  required

  respond

   a  collection  of  information  unless  it  displays  a  valid  OMB  control  number. 
to
to
Under  the  Paperwork  Reduction Act
no
are

REISSUE PATENT APPLICATION TRANSMITTAL 
Address to: 

Attorney Docket No. 

         Mail Stop Reissue 
         Commissioner for Patents 
         P.O. Box 1450 
         Alexandria, VA  22313‐1450 

First Named Inventor 

Original Patent Number 

Original Patent Issue Date
(Month/Day/Year) 

  Express®

  Label
  No.
Priority Mail

APPLICATION FOR REISSUE OF: 
          (Check applicable box)                                                            Utility Patent                                   Design Patent                                    Plant Patent 

APPLICATION ELEMENTS (37 CFR 1.173)

ACCOMPANYING APPLICATION PARTS 

1.          Fee Transmittal Form (PTO/SB/56) 
2.          Applicant asserts small entity status. See 37 CFR 1.27 
3.          Applicant certifies micro entity status. See 37 CFR 1.29. 
             Applicant must attach form PTO/SB/15A or B or equivalent. 
4.          Specification and Claims in double column copy of patent format 
             (amended, if appropriate) 
5.          Drawing(s) (proposed amendments, if appropriate) 
6.          Reissue Oath/Declaration or Substitute Statement 
             (37 CFR 1.175) (PTO/AIA/05, 06, or 07) 
7.          Application Data Sheet     NOTE:  Benefit claims under 37 CFR 1.78 
               and foreign priority claims under 37 CFR 1.55 MUST be set forth in an 
               Application Data Sheet (ADS). 

8.          Original U.S. Patent currently assigned?          Yes          No 
               (If Yes, check applicable box(es)) 

11.          Statement of status and support for all changes to the 
                claims. See 37 CFR 1.173(c). 
12.          Power of Attorney 
13.          Information Disclosure Statement (IDS) 
               PTOSB/08 or PTO‐1449 
                           Copies of citations attached 

14.          English translation of Reissue Oath/Declaration 
                (if applicable) 
15.          Return Receipt Postcard (MPEP § 503) 
                (Should be specifically itemized) 
16.          Preliminary Amendment (37 CFR 1.173; MPEP § 1453) 

17.          Other: ____________________________________________ 
                __________________________________________________ 

                    Written Consent of all Assigness (PTO/AIA/53) 

                __________________________________________________ 

                    37 CFR 3.73(c) Statement (PTO/AIA/96) 
9.          CD‐ROM or CD‐R in duplicate, Computer Program (Appendix) or large
                table 

                __________________________________________________ 
                __________________________________________________ 

                    Landscape Table on CD 
10.  Nucleotide and/or Amino Acid Sequence Submission 
       (if applicable, items a. – c. are required) 

                __________________________________________________ 

      a.          Computer Readable Form (CRF) 

                This is a continuation reissue or divisional reissue application 
                (i.e., a second or subsequent reissue application for the same 
issued patent). (Check box if applicable.) 

                __________________________________________________ 

      b.          Specification Sequence Listing on: 
             i.          CD‐ROM (2 copies) or CD‐R (2 copies); or 
             ii.         Paper 
      c.          Statements verifying identity of above copies 

18.  CORRESPONDENCE ADDRESS 

          The address associated with Customer Number: __________________________________        OR             Correspondence address below 
Name 

Address 

City 

Country 

Email 

Signature 

Name (Print/Type) 

State

Zip Code 

Telephone

Date

Registration No.

   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    
A Federal
agency
information
to the requirements
collection
Number.
The  
    collection subject

 of the
   Paperwork

  Reduction

 Act of
  1995,
  unless

 the information

    has  a valid
  OMB  Control

OMB Control
for  this form
to  average
including
  Number  for this information
    collection  is 0651-0033.
  Public
    burden

    is estimated

  30
  minutes per response,

   the  time
for reviewing
searching
existing
    instructions,

   data  sources,  gathering and
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  the
  data needed,

  and
  completing
      and  reviewing the
  information

  collection.

Send comments
regarding
collection,
suggestions

  this burden
    estimate or  any  other
  aspect
  of this information

    including

    for reducing
  this burden
    to  the Office  of the 
Chief
Officer,
United States
Office,
P.O. Box
VA 22313-1450 or email InformationCollection@uspto.gov.
  Administrative

    Patent and
  Trademark

   1450, Alexandria,

   for Patents,

  1450, Alexandria,

 VA 22313‐1450.

SEND TO: Mail Stop Reissue, Commissioner
P.O.  Box
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, pursuant to the
requirements of the Act, please be advised that: (1) the general authority for the collection of this information is
35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary; and (3) the principal purpose for which
the information is used by the U.S. Patent and Trademark Office is to process and/or examine your submission
related to a patent application or patent. If you do not furnish the requested information, the U.S. Patent and
Trademark Office may not be able to process and/or examine your submission, which may result in termination
of proceedings or 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:
1.

2.
3.
4.

5.
6.
7.

8.

9.

The information on this form will be treated confidentially to the extent allowed under the Freedom of
Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from this system of
records may be disclosed to the Department of Justice to determine whether disclosure of these
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552a(m).
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system of records may be disclosed, as a routine use, to the International Bureau of the World
Intellectual Property Organization, pursuant to the Patent Cooperation Treaty.
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(42 U.S.C. 218(c)).
A record from this system of records may be disclosed, as a routine use, to the Administrator, General
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A record from this system of records may be disclosed, as a routine use, to the public after either
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U.S.C. 151. Further, a record may be disclosed, subject to the limitations of 37 CFR 1.14, as a routine
use, to the public 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 inspection or an issued patent.
A record from this system of records may be disclosed, as a routine use, to a Federal, State, or local
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