Form 37 Cfr 1.76 - Application Data Sheet

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PTO/AIA/14 (03-13)
Approved for use through 01/31/2014. OMB 0651-0032
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.
Attorney Docket Number
Application Data Sheet 37 CFR 1.76
Application Number
Title of Invention
The application data sheet is part of the provisional or nonprovisional application for which it is being submitted. The following form contains the
bibliographic data arranged in a format specified by the United States Patent and Trademark Office as outlined in 37 CFR 1.76.
This document may be completed electronically and submitted to the Office in electronic format using the Electronic Filing System (EFS) or the
document may be printed and included in a paper filed application.
Secrecy Order 37 CFR 5.2
pplication Data Sheet may fall under a Secrecy Order pursuant to
Portions or all of the application associated with this A
37 CFR 5.2 (Paper filers only. Applications that fall under Secrecy Order may not be filed electronically.)
Inventor Information:
Inventor
Remove
Legal Name
Prefix Given Name
Middle Name
Family Name
Suffix
Residence Information (Select One)
US Residency
Non US Residency
Active US Military Service
City
State/Province
Country of Residence
i
City
Country of Residence
i
Mailing Address of Inventor:
Address 1
Address 2
City
State/Province
Postal Code
Country
i
All Inventors Must Be Listed - Additional Inventor Information blocks may be
Add
generated within this form by selecting the Add button.
Correspondence Information:
Enter either Customer Number or complete the Correspondence Information section below.
For further information see 37 CFR 1.33(a).
An Address is being provided for the correspondence Information of this application.
Customer Number
Name 1
Name 2
Address 1
Address 2
City
State/Province
i
Country
Postal Code
Phone Number
Fax Number
Email Address
Add Email
Remove Email
EFS Web 2.2.8

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