Form Pto/aia/06 - Reissue Application Declaration By The Assignee

Download a blank fillable Form Pto/aia/06 - Reissue Application Declaration By The Assignee in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Pto/aia/06 - Reissue Application Declaration By The Assignee with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Doc Code: REIS.DECL

Doc Code:

Document Description: Reissue Declaration Filed In Accordance With MPEP 1414

PTO/AIA/06 (02-17)

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

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.

Docket Number (optional)

REISSUE APPLICATION DECLARATION BY THE ASSIGNEE

I hereby declare that:

The residence and mailing address of the inventor or joint inventors are stated below.

Name of the Assignee:

I am authorized to act on behalf of the assignee (if the assignee is a juristic entity).

The entire title to the patent identified below is vested in said assignee, or if there are multiple assignees/owners, all

assignees/owners have executed a Reissue Application Declaration to account for the entire title of the patent identified

below.

Inventor

Residence: City

State

Country

Mailing Address

City

State

Zip

Country

Additional Inventors are named on separately numbered sheets attached hereto.

Patent Issue Date

Patent Number

I believe said inventor(s) to be the original inventor or original joint inventors of the subject matter which is described and

claimed in said patent, for which a reissue patent is sought on the invention titled:

the specification of which

is attached hereto.

was filed on

as reissue application number

The above-identified application was made or authorized to be made by me.

I hereby acknowledge that any willful false statement made in this declaration is punishable under 18 U.S.C. 1001 by fine

or imprisonment of not more than five (5) years, or both.

I believe the original patent to be wholly or partly inoperative or invalid, for the reasons described below.

(Check all boxes that apply.)

by re

ason of a defective specification or drawing.

by re

ason of the patentee claiming more or less than he had the right to claim in the patent.

by reas

on of other errors.

[Page 1 of 2]

This collection of information is required by 37 CFR 1.175. 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 30 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

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

ADDRESS.

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