Form PTO/SB/96 Statement under 37 CFR 3.73(b)

PTO/SB/96 (11-18)
Approved for use through XX/XX/XXXX. OMB 0651-0031
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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STATEMENT UNDER 37 CFR 3.73(b)
Applicant/Patent Owner:
Application No./Patent No.:

Filed/Issue Date:

Titled:

,a
(Name of Assignee)

(Type of Assignee, e.g., corporation, partnership, university, government agency, etc.

states that it is:
1.

the assignee of the entire right, title, and interest in;

2.

an assignee of less than the entire right, title, and interest in
(The extent (by percentage) of its ownership interest is

3.

the assignee of an undivided interest in the entirety of (a complete assignment from one of the joint inventors was made)

%); or

the patent application/patent identified above, by virtue of either:
A.
OR
B.

An assignment from the inventor(s) of the patent application/patent identified above. The assignment was recorded in
the United States Patent and Trademark Office at Reel
, Frame
, or a copy*
is attached.
A chain of title from the inventor(s), of the patent application/patent identified above, to the current assignee as follows:
1. From:

To:
The document was recorded in the United States Patent and Trademark Office at
Reel

,

Frame

2. From:

,

or a copy* is attached.

To:
The document was recorded in the United States Patent and Trademark Office at
Reel

,

Frame

3. From:

,

or a copy* is attached.

To:
The document was recorded in the United States Patent and Trademark Office at
Reel

,

Frame

,

or a copy* is attached.

Additional documents in the chain of title are listed on a supplemental sheet(s).
*As required by 37 CFR 3.73(b)(1)(i), if a copy/copies is/are attached, the documentary evidence of the chain of title from the
original owner to the assignee was, or concurrently is being, submitted for recordation pursuant to 37 CFR 3.11.
[NOTE: A separate copy (i.e., a true copy of the original assignment document(s)) must be submitted to Assignment Division in
accordance with 37 CFR Part 3, to record the assignment in the records of the USPTO. See MPEP 302.]
The undersigned (whose title is supplied below) is authorized to act on behalf of the assignee.
Signature

Printed or Typed Name

Date

Title or Registration Number

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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 15 minutes to complete, including
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you require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Administrative Officer, U.S. Patent and Trademark Office, U.S.
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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.

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Files, available at Federal Register /Vol. 78, No. 61 / Friday, March 29, 2013 /Notices 19243. https://
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