Form Pto/aia/05 - Reissue Application Declaration By The Inventor

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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 INVENTOR
I hereby declare that: 
Each inventor’s residenceDQG mailing address are stated below next to their name. 
I believe ,DPWKHRULJLQDOLQYHQWRURUDQRULJLQDOMRLQWLQYHQWRU of the subject matter which is described and claimed
in patent number 
, granted
and for which a
reissue patent is sought on the invention titled 
_______BB_________________________________________________,
,
the specification of which
is attached hereto.
was filed on
as reissue application number
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I KHUHE\DFNQRZOHGJHWKDWDQ\ZLOOIXOIDOVHVWDWHPHQWPDGHLQWKLVGHFODUDWLRQLVSXQLVKDEOHXQGHU1886&E\ILQH
RULPSULVRQPHQWRIQRWPRUHWKDQILYH  \HDUVRUERWK.
I believe the original patent to be wholly or partly inoperative or invalid, for the reasons described
below. (Check all boxes that apply.)
by reason of a defective specification or drawing.
by reason of the patentee claiming more or less than he had the right to claim in the patent.
by reason of other errors.
At least one error upon which reissue is based is described below.If the reissue is a broadening
reissue, DFODLPWKDWWKHDSSOLFDWLRQVHHNVWREURDGHQPXVWEHLGHQWLILHG:
[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
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.

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