STATUTORY
INVENTION REGISTRATION REQUEST
Application
Serial Number: ______________________
(Or attach application with request)
Filed: _________________________
Titled:
________________________________________________________________
Applicant(s):
__________________________________________________________
I
hereby request the Commissioner of Patents and Trademarks to publish the
regularly filed patent application identified above as a Statutory Invention
Registration. I also waive the right to
receive a United States patent on the same invention claimed in that
application. I also understand that
upon publication of the Statutory Invention Registration, this waiver will
effectively waive my right to receive a United States patent on the invention
claimed in the Statutory Invention Registration.
In
my opinion, the disclosures and claims of the above patent application meet the
requirements of section 112 of Title 35 of the United States Code.
I
have enclosed the required fee for requesting publication of a Statutory
Invention Registration which amounts to $ ____________________.
List
below the name(s) of not more than 3 registered patent attorneys or agents if
you wish to have their names printed on the front page of the Statutory
Invention Registration:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
List
below the name of any assignee whose name you wish to be printed on the
Statutory Invention Registration:
_____________________________________________________________
(Name)
___________________________________________________________
(Address)
______________________________________
(State of Incorporation, If Applicable)
___________________________________ ___________________
Signature
of Applicant Date
___________________________________ ___________________
Signature
of Assignee Date
___________________________________ ___________________
Signature
of Attorney/Agent Date
