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Form Pto/aia/53 - Reissue Application: Consent Of Assignee; Statement Of Non-Assignment

PTO/AIA/53 (09-12)

Approved for use through 01/31/2020. OMB 0651-0033

U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE

Under t he Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.

Docket Number (Optional)

REISSUE APPLICATION: CONSENT OF ASSIGNEE;

STATEMENT OF NON-ASSIGNMENT

This is part of the application for a reissue patent based on the original patent identified below.

Name of Patentee(s)

Patent Number

Date Patent Issued

Title of Invention

Filed herein is a statement under 37 CFR 3.73(c). (Form PTO/AIA/96)

Ownership of the patent is in the inventor(s), and no assignment of the patent is in effect.

One of boxes 1 or 2 above must be checked. If multiple assignees, complete this form for each assignee. If

box 2 is checked, skip the next entry and go directly to “Name of Assignee.”

The written consent of all assignees and inventors ow ning an undivided interest in the original

patent is included in this application for reissue.

The assignee(s) owning an undivided interest in said original patent is/are

and the assignee(s) consents to the accompanying application for reissue.

Name of assignee/inventor (if not assigned)

Signature

Date

Typed or printed name and title of person signing for assignee (if assigned)

This collection of information is required by 37 CFR 1.172. 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 1.14. This collection is estimated to take 6 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

Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450

ADDRESS. SEND TO:

If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.