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Statement Under 37 CFR 3.73(c) PTO-AIA-96 - Official Federal Forms
| Statement Under 37 CFR 3.73(c) Form. This is a national form and can be used in Patent US Patent Office . |
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PTO/$,$/96 (08-12) Approved for use through 01/31/2013. OMB 0651-0031 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. STATEMENT UNDER 37 CFR 3.73(c) 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, for the patent application/patent identified above, it is (choose one of options 1, 2, 3 or 4 below): 1. 2. The assignee of the entire right, title, and interest. An assignee of less than the entire right, title, and interest (check applicable box): The extent (by percentage) of its ownership interest is ____________%. Additional Statement(s) by the owners holding the balance of the interest must be submitted to account for 100% of the ownership interest. There are unspecified percentages of ownership. The other parties, including inventors, who together own the entire right, title and interest are: Additional Statement(s) by the owner(s) holding the balance of the interest must be submitted to account for the entire right, title, and interest. 3. The assignee of an undivided interest in the entirety (a complete assignment from one of the joint inventors was made). The other parties, including inventors, who together own the entire right, title, and interest are: Additional Statement(s) by the owner(s) holding the balance of the interest must be submitted to account for the entire right, title, and interest. 4. The recipient, via a court proceeding or the like (e.g., bankruptcy, probate), of an undivided interest in the entirety (a complete transfer of ownership interest was made). The certified document(s) showing the transfer is attached. The interest identified in option 1, 2 or 3 above (not option 4) is evidenced by either (choose one of options A or B below): A. 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 for which a copy thereof 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 ____________, or for which a copy thereof is attached. 2. From: _________________________________________ To: _________________________________________ The document was recorded in the United States Patent and Trademark Office at Reel ____________, Frame ____________, or for which a copy thereof is attached. B. [Page 1 of 2] This collection of information is required by 37 CFR 3.73(b). The information is required to obtain or retain a benefit by the public which is to file (and by the USPTO to 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 12 minutes to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any comments on the amount of time you require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S. Patent and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS 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. American LegalNet, Inc. www.FormsWorkFlow.com PTO/$,$/96 (08-12) Approved for use through 01/31/2013. OMB 0651-0031 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. STATEMENT UNDER 37 CFR 3.73(c) 3. From: _________________________________________ To: _________________________________________ The document was recorded in the United States Patent and Trademark Office at Reel ____________, Frame ____________, or for which a copy thereof is attached. 4. From: _________________________________________ To: _________________________________________ The document was recorded in the United States Patent and Trademark Office at Reel ____________, Frame ____________, or for which a copy thereof is attached. 5. From: _________________________________________ To: _________________________________________ The document was recorded in the United States Patent and Trademark Office at Reel ____________, Frame ____________, or for which a copy thereof is attached. 6. From: _________________________________________ To: _________________________________________ The document was recorded in the United States Patent and Trademark Office at Reel ____________, Frame ____________, or for which a copy thereof is attached. Additional documents in the chain of title are listed on a supplemental sheet(s). As required by 37 CFR 3.73(c)(1)(i), 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 302.08] 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 [Page 2 of 2] American LegalNet, Inc. www.FormsWorkFlow.
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