Form Pto/aia/07 - Substitute Statement In Lieu Of An Oath Or Declaration For Reissue Patent Application (35 U.s.c. 115(D) And 37 Cfr 1.64)

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Doc code: REIS.DECL
Document Description: Reissue Declaration Filed In Accordance With MPEP 1414
PTO/AIA/07 (0-1)
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.
SUBSTITUTE STATEMENT IN LIEU OF AN OATH OR DECLARATION FOR
REISSUE PATENT APPLICATION (35 U.S.C. 115(d) AND 37 CFR 1.64)
Title of
Invention
This statement is directed to:
The attached application,
OR
was filed on ____________________ as reissue application number ___________________.
LEGAL NAME of inventor to whom this substitute statement applies:
(E.g., Given Name (first and middle (if any)) and Family Name or Surname)
Residence (except for a deceased or legally incapacitated inventor):
City
State
Country
Mailing Address (except for a deceased or legally incapacitated inventor):
City
Country
State
Zip
I believe the above-named inventor or joint inventor to be the original inventor or an original joint inventor of a claimed invention
in the application.
The above-identified application was made or authorized to be made by me.
I hereby acknowledge that any willful false statement made in this statement is punishable under 18 U.S.C. 1001 by fine or
imprisonment of not more than five (5) years, or both.
Relationship to the inventor to whom this substitute statement applies:
Legal Representative (for deceased or legally incapacitated inventor only),
Assignee, or
Joint Inventor.
Circumstances permitting execution of this substitute statement:
Inventor is deceased,
Inventor is under legal incapacity,
Inventor cannot be found or reached after diligent effort, or
Inventor has refused to execute the oath or declaration under 37 CFR 1.175.
[Page 1 of 3]
This collection of information is required by 35 U.S.C. 115 and 37 CFR 1.63. 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 1 minute 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
SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
THIS ADDRESS.
If you need assistance in completing the
form, call 1-800-PTO-9199 and select option 2.

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