+--------------+-------------------+------+---+-----+---+-------------+
| ## ![](m     |                   |      |   |     |   |             |
| edia/image1. |                   |      |   |     |   |             |
| png){width=" |                   |      |   |     |   |             |
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| ht="0.75in"} |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
| **INVENTION  |                   |      |   |     | D |             |
| RIGHTS**     |                   |      |   |     | I |             |
|              |                   |      |   |     | S |             |
|              |                   |      |   |     | C |             |
|              |                   |      |   |     | L |             |
|              |                   |      |   |     | O |             |
|              |                   |      |   |     | S |             |
|              |                   |      |   |     | U |             |
|              |                   |      |   |     | R |             |
|              |                   |      |   |     | E |             |
|              |                   |      |   |     | N |             |
|              |                   |      |   |     | O |             |
|              |                   |      |   |     | . |             |
+--------------+-------------------+------+---+-----+---+-------------+
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|              |                   |      |   |     | i |             |
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|              |                   |      |   |     | a |             |
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+--------------+-------------------+------+---+-----+---+-------------+
| #            |                   |      |   |     |   |             |
| INSTRUCTIONS |                   |      |   |     |   |             |
+--------------+-------------------+------+---+-----+---+-------------+
| **General:** |                   | *    |   |     |   |             |
|              |                   | *Spe |   |     |   |             |
| > 1\. Under  |                   | cifi |   |     |   |             |
| > Executive  |                   | c:** |   |     |   |             |
| > Order      |                   |      |   |     |   |             |
| > 10096, 23  |                   | 1.   |   |     |   |             |
| > January    |                   |  1\. |   |     |   |             |
| > 1950 as    |                   |      |   |     |   |             |
| > amended by |                   | Sepa |   |     |   |             |
| > Executive  |                   | rate |   |     |   |             |
| > Order      |                   |      |   |     |   |             |
| > 10930, and |                   |    f |   |     |   |             |
| > DOT Order  |                   | orms |   |     |   |             |
| > 2100.3,    |                   |      |   |     |   |             |
| > whenever   |                   | will |   |     |   |             |
| > an         |                   |      |   |     |   |             |
| > invention  |                   |   be |   |     |   |             |
| > is made by |                   |      |   |     |   |             |
| > Department |                   |    s |   |     |   |             |
| > of         |                   | ubmi |   |     |   |             |
| > Tr         |                   | tted |   |     |   |             |
| ansportation |                   |      |   |     |   |             |
| > personnel  |                   |   in |   |     |   |             |
| > it is      |                   |      |   |     |   |             |
| > necessary  |                   |    d |   |     |   |             |
| > to         |                   | upli |   |     |   |             |
| > determine  |                   | cate |   |     |   |             |
| > the rights |                   |      |   |     |   |             |
| > in the     |                   | toge |   |     |   |             |
| > invention  |                   | ther |   |     |   |             |
| > as between |                   |      |   |     |   |             |
| > the        |                   | with |   |     |   |             |
| > Government |                   |      |   |     |   |             |
| > and the    |                   |    d |   |     |   |             |
| > inventor.  |                   | upli |   |     |   |             |
| > There are  |                   | cate |   |     |   |             |
| > three ways |                   |      |   |     |   |             |
| > in which   |                   |   co |   |     |   |             |
| > rights may |                   | pies |   |     |   |             |
| > be         |                   |      |   |     |   |             |
| >            |                   |   of |   |     |   |             |
|  determined: |                   |      |   |     |   |             |
| > (1) the    |                   |  DOT |   |     |   |             |
| > inventor   |                   |      |   |     |   |             |
| > may be     |                   | Form |   |     |   |             |
| > entitled   |                   |      |   |     |   |             |
| > all rights |                   |  200 |   |     |   |             |
| > and the    |                   | 0.1, |   |     |   |             |
| > Government |                   |      |   |     |   |             |
| > to none    |                   |   Di |   |     |   |             |
| > (and hence |                   | sclo |   |     |   |             |
| > the        |                   | sure |   |     |   |             |
| > inventor   |                   |      |   |     |   |             |
| > need sign  |                   |   of |   |     |   |             |
| > no         |                   |      |   |     |   |             |
| > document   |                   |   In |   |     |   |             |
| > giving any |                   | vent |   |     |   |             |
| > rights to  |                   | ions |   |     |   |             |
| > the        |                   |      |   |     |   |             |
| >            |                   |  and |   |     |   |             |
| Government); |                   |      |   |     |   |             |
| > (2) the    |                   |  DOT |   |     |   |             |
| > Government |                   |      |   |     |   |             |
| > may be     |                   | Form |   |     |   |             |
| > entitled   |                   |      |   |     |   |             |
| > to a       |                   |  200 |   |     |   |             |
| > license    |                   | 0.2, |   |     |   |             |
| > permitting |                   |      |   |     |   |             |
| > it to use  |                   |   Re |   |     |   |             |
| > and        |                   | cord |   |     |   |             |
| > practice   |                   |      |   |     |   |             |
| > the        |                   |   of |   |     |   |             |
| > invention  |                   |      |   |     |   |             |
| > and the    |                   |   In |   |     |   |             |
| > inventor   |                   | vent |   |     |   |             |
| > entitled   |                   | ions |   |     |   |             |
| > to all     |                   |      |   |     |   |             |
| > other      |                   |   to |   |     |   |             |
| > right      |                   |      |   |     |   |             |
| > (hence the |                   |  the |   |     |   |             |
| > inventor   |                   |      |   |     |   |             |
| > signs a    |                   |   Of |   |     |   |             |
| > license to |                   | fice |   |     |   |             |
| > the        |                   |      |   |     |   |             |
| >            |                   |   of |   |     |   |             |
| Government); |                   |      |   |     |   |             |
| > (3) the    |                   |   Pa |   |     |   |             |
| > Government |                   | tent |   |     |   |             |
| > may be     |                   |      |   |     |   |             |
| > entitled   |                   |  Cou |   |     |   |             |
| > to all     |                   | nsel |   |     |   |             |
| > rights and |                   |      |   |     |   |             |
| > the        |                   |   in |   |     |   |             |
| > inventor   |                   |      |   |     |   |             |
| > to none    |                   |   ac |   |     |   |             |
| > (and hence |                   | cord |   |     |   |             |
| > the        |                   | ance |   |     |   |             |
| > inventor   |                   |      |   |     |   |             |
| > signs an   |                   | with |   |     |   |             |
| > assignment |                   |      |   |     |   |             |
| > to the     |                   |    p |   |     |   |             |
| >            |                   | arag |   |     |   |             |
| Government). |                   | raph |   |     |   |             |
| >            |                   |      |   |     |   |             |
| > 2\.        |                   |   6, |   |     |   |             |
| > Separate   |                   |      |   |     |   |             |
| > and        |                   |  DOT |   |     |   |             |
| > distinct   |                   |      |   |     |   |             |
| > from the   |                   |  210 |   |     |   |             |
| > d          |                   | 0.3, |   |     |   |             |
| etermination |                   |      |   |     |   |             |
| > of rights, |                   |   by |   |     |   |             |
| > and even   |                   |      |   |     |   |             |
| > though it  |                   |  the |   |     |   |             |
| > may appear |                   |      |   |     |   |             |
| > that the   |                   | inve |   |     |   |             |
| > inventor   |                   | ntor |   |     |   |             |
| > is         |                   |      |   |     |   |             |
| > entitled   |                   |  and |   |     |   |             |
| > to all     |                   |      |   |     |   |             |
| > rights in  |                   | each |   |     |   |             |
| > the        |                   |      |   |     |   |             |
| > invention, |                   | co-i |   |     |   |             |
| > the        |                   | nven |   |     |   |             |
| > inventor   |                   | tor. |   |     |   |             |
| > may sign a |                   |      |   |     |   |             |
| > license    |                   | 2.   |   |     |   |             |
| > permitting |                   |  2\. |   |     |   |             |
| > the        |                   |      |   |     |   |             |
| > Government |                   |    P |   |     |   |             |
| > to use and |                   | rint |   |     |   |             |
| > practice   |                   |      |   |     |   |             |
| > the        |                   |   or |   |     |   |             |
| > invention  |                   |      |   |     |   |             |
| > in return  |                   | type |   |     |   |             |
| > for which  |                   |      |   |     |   |             |
| > the        |                   |  all |   |     |   |             |
| > Government |                   |      |   |     |   |             |
| > will       |                   | answ |   |     |   |             |
| > prosecute  |                   | ers. |   |     |   |             |
| > an         |                   |      |   |     |   |             |
| >            |                   | 3.   |   |     |   |             |
|  application |                   |  3\. |   |     |   |             |
| > for a      |                   |      |   |     |   |             |
| > patent on  |                   |   If |   |     |   |             |
| > the        |                   |      |   |     |   |             |
| > invention  |                   |  the |   |     |   |             |
| > at no      |                   |      |   |     |   |             |
| > expense to |                   | inve |   |     |   |             |
| > the        |                   | ntor |   |     |   |             |
| > inventor,  |                   |      |   |     |   |             |
| > provided   |                   | (and |   |     |   |             |
| > the        |                   |      |   |     |   |             |
| > Government |                   |    c |   |     |   |             |
| > is         |                   | o-in |   |     |   |             |
| >            |                   | vent |   |     |   |             |
| sufficiently |                   | ors) |   |     |   |             |
| > interested |                   |      |   |     |   |             |
| > in the     |                   |   de |   |     |   |             |
| > invention. |                   | sire |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   to |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  vol |   |     |   |             |
|              |                   | unta |   |     |   |             |
|              |                   | rily |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   as |   |     |   |             |
|              |                   | sign |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  all |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   ri |   |     |   |             |
|              |                   | ghts |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   in |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    i |   |     |   |             |
|              |                   | nven |   |     |   |             |
|              |                   | tion |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   to |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  Gov |   |     |   |             |
|              |                   | ernm |   |     |   |             |
|              |                   | ent, |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   he |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   sh |   |     |   |             |
|              |                   | ould |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    c |   |     |   |             |
|              |                   | heck |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   7a |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    b |   |     |   |             |
|              |                   | elow |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   as |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  app |   |     |   |             |
|              |                   | lica |   |     |   |             |
|              |                   | ble, |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | comp |   |     |   |             |
|              |                   | lete |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  ans |   |     |   |             |
|              |                   | wers |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   to |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | ques |   |     |   |             |
|              |                   | tion |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    7 |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   of |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | this |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    q |   |     |   |             |
|              |                   | uest |   |     |   |             |
|              |                   | ionn |   |     |   |             |
|              |                   | aire |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  and |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | sign |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   in |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    p |   |     |   |             |
|              |                   | lace |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | prov |   |     |   |             |
|              |                   | ided |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   at |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  end |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   of |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  que |   |     |   |             |
|              |                   | stio |   |     |   |             |
|              |                   | n 7. |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  The |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    r |   |     |   |             |
|              |                   | emai |   |     |   |             |
|              |                   | ning |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    q |   |     |   |             |
|              |                   | uest |   |     |   |             |
|              |                   | ions |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | then |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | need |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   to |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   be |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    a |   |     |   |             |
|              |                   | nswe |   |     |   |             |
|              |                   | red. |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | 4.   |   |     |   |             |
|              |                   |  4\. |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   If |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | inve |   |     |   |             |
|              |                   | ntor |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | does |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  not |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   de |   |     |   |             |
|              |                   | sire |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   to |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  vol |   |     |   |             |
|              |                   | unta |   |     |   |             |
|              |                   | rily |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   as |   |     |   |             |
|              |                   | sign |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  all |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   ri |   |     |   |             |
|              |                   | ghts |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   in |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    i |   |     |   |             |
|              |                   | nven |   |     |   |             |
|              |                   | tion |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   to |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  Gov |   |     |   |             |
|              |                   | ernm |   |     |   |             |
|              |                   | ent, |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   it |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   is |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    n |   |     |   |             |
|              |                   | eces |   |     |   |             |
|              |                   | sary |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | that |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  all |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    q |   |     |   |             |
|              |                   | uest |   |     |   |             |
|              |                   | ions |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   be |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | answ |   |     |   |             |
|              |                   | ered |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  com |   |     |   |             |
|              |                   | plet |   |     |   |             |
|              |                   | ely. |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  The |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    d |   |     |   |             |
|              |                   | eter |   |     |   |             |
|              |                   | mina |   |     |   |             |
|              |                   | tion |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   of |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   ri |   |     |   |             |
|              |                   | ghts |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   in |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    i |   |     |   |             |
|              |                   | nven |   |     |   |             |
|              |                   | tion |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  dep |   |     |   |             |
|              |                   | ends |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | upon |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    f |   |     |   |             |
|              |                   | acts |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  and |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    c |   |     |   |             |
|              |                   | ircu |   |     |   |             |
|              |                   | msta |   |     |   |             |
|              |                   | nces |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    u |   |     |   |             |
|              |                   | nder |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    w |   |     |   |             |
|              |                   | hich |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    i |   |     |   |             |
|              |                   | nven |   |     |   |             |
|              |                   | tion |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  was |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    m |   |     |   |             |
|              |                   | ade. |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   In |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   al |   |     |   |             |
|              |                   | most |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    e |   |     |   |             |
|              |                   | very |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    c |   |     |   |             |
|              |                   | ase, |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    a |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  fai |   |     |   |             |
|              |                   | lure |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   to |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  pro |   |     |   |             |
|              |                   | vide |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   su |   |     |   |             |
|              |                   | ffic |   |     |   |             |
|              |                   | ient |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  inf |   |     |   |             |
|              |                   | orma |   |     |   |             |
|              |                   | tion |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    w |   |     |   |             |
|              |                   | orks |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   to |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | disa |   |     |   |             |
|              |                   | dvan |   |     |   |             |
|              |                   | tage |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   of |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    i |   |     |   |             |
|              |                   | nven |   |     |   |             |
|              |                   | tor. |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    E |   |     |   |             |
|              |                   | very |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | ques |   |     |   |             |
|              |                   | tion |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | must |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   be |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    a |   |     |   |             |
|              |                   | nswe |   |     |   |             |
|              |                   | red. |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   If |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | more |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    s |   |     |   |             |
|              |                   | pace |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   is |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   ne |   |     |   |             |
|              |                   | eded |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   to |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    f |   |     |   |             |
|              |                   | ully |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   an |   |     |   |             |
|              |                   | swer |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  any |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  que |   |     |   |             |
|              |                   | stio |   |     |   |             |
|              |                   | n(s) |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  use |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    b |   |     |   |             |
|              |                   | lank |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  she |   |     |   |             |
|              |                   | ets, |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | iden |   |     |   |             |
|              |                   | tify |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  the |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | ques |   |     |   |             |
|              |                   | tion |   |     |   |             |
|              |                   | s(s) |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  and |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  att |   |     |   |             |
|              |                   | ach. |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |    P |   |     |   |             |
|              |                   | rint |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |   or |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | type |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |  all |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | answ |   |     |   |             |
|              |                   | ers. |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   | ``   |   |     |   |             |
|              |                   | `{=h |   |     |   |             |
|              |                   | tml} |   |     |   |             |
|              |                   | <!-- |   |     |   |             |
|              |                   |  --> |   |     |   |             |
|              |                   | ```  |   |     |   |             |
|              |                   | 1.   |   |     |   |             |
+--------------+-------------------+------+---+-----+---+-------------+
| #            |                   |      |   |     |   |             |
|  SECTION A.  |                   |      |   |     |   |             |
| - BASIC DATA |                   |      |   |     |   |             |
+--------------+-------------------+------+---+-----+---+-------------+
| 1\. BRIEF    |                   | 2\.  |   |     |   |             |
| TITLE OF     |                   | NAME |   |     |   |             |
| INVENTION    |                   | OF   |   |     |   |             |
|              |                   | INVE |   |     |   |             |
|              |                   | NTOR |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
+--------------+-------------------+------+---+-----+---+-------------+
| 3\. TITLE OF |                   | 4\.  |   |     |   |             |
| POSITION OR  |                   | G    |   |     |   |             |
| DUTY         |                   | RADE |   |     |   |             |
| ASSIGNMENT   |                   | AT   |   |     |   |             |
|              |                   | TIME |   |     |   |             |
|              |                   | I    |   |     |   |             |
|              |                   | NVEN |   |     |   |             |
|              |                   | TION |   |     |   |             |
|              |                   | WAS  |   |     |   |             |
|              |                   | MADE |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
+--------------+-------------------+------+---+-----+---+-------------+
| 5\. NAME AND |                   |      | R |     |   | WORK PHONE  |
| ADDRESS OF   |                   |      | O |     |   |             |
| AGENCY       |                   |      | U |     |   |             |
| ACTIVITY     |                   |      | T |     |   |             |
| WHERE        |                   |      | I |     |   |             |
| EMPLOYED     |                   |      | N |     |   |             |
|              |                   |      | G |     |   |             |
|              |                   |      | S |     |   |             |
|              |                   |      | Y |     |   |             |
|              |                   |      | M |     |   |             |
|              |                   |      | B |     |   |             |
|              |                   |      | O |     |   |             |
|              |                   |      | L |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
+--------------+-------------------+------+---+-----+---+-------------+
| 6\. BRIEF    |                   |      |   |     |   |             |
| SUMMARY OF   |                   |      |   |     |   |             |
| INVENTION    |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
+--------------+-------------------+------+---+-----+---+-------------+
| 7\. KEEPING  |                   |      |   |     |   |             |
| IN MIND THE  |                   |      |   |     |   |             |
| STATEMENTS   |                   |      |   |     |   |             |
| OF PARAGRAPH |                   |      |   |     |   |             |
| 1 AND 2 OF   |                   |      |   |     |   |             |
| THE ABOVE    |                   |      |   |     |   |             |
| I            |                   |      |   |     |   |             |
| NSTRUCTIONS, |                   |      |   |     |   |             |
| CHECK ONE OF |                   |      |   |     |   |             |
| THE          |                   |      |   |     |   |             |
| FOLLOWING.   |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
| a. I desire  |                   |      |   |     |   |             |
| to assign to |                   |      |   |     |   |             |
| the United   |                   |      |   |     |   |             |
| States       |                   |      |   |     |   |             |
| Government   |                   |      |   |     |   |             |
| the entire   |                   |      |   |     |   |             |
| right, title |                   |      |   |     |   |             |
| and interest |                   |      |   |     |   |             |
| in and to    |                   |      |   |     |   |             |
| the above    |                   |      |   |     |   |             |
| identified   |                   |      |   |     |   |             |
| invention.   |                   |      |   |     |   |             |
| (For the     |                   |      |   |     |   |             |
| record, I    |                   |      |   |     |   |             |
| have been    |                   |      |   |     |   |             |
| advised of   |                   |      |   |     |   |             |
| the full     |                   |      |   |     |   |             |
| import of an |                   |      |   |     |   |             |
| assignment   |                   |      |   |     |   |             |
| and am aware |                   |      |   |     |   |             |
| of my rights |                   |      |   |     |   |             |
| of appeal    |                   |      |   |     |   |             |
| under        |                   |      |   |     |   |             |
| Executive    |                   |      |   |     |   |             |
| Order 10096, |                   |      |   |     |   |             |
| as amended   |                   |      |   |     |   |             |
| by Executive |                   |      |   |     |   |             |
| Order        |                   |      |   |     |   |             |
| 10930.)      |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
| b. I desire  |                   |      |   |     |   |             |
| to license   |                   |      |   |     |   |             |
| the United   |                   |      |   |     |   |             |
| States       |                   |      |   |     |   |             |
| Government   |                   |      |   |     |   |             |
| in the above |                   |      |   |     |   |             |
| identified   |                   |      |   |     |   |             |
| invention in |                   |      |   |     |   |             |
| accordance   |                   |      |   |     |   |             |
| with 1(b) of |                   |      |   |     |   |             |
| Executive    |                   |      |   |     |   |             |
| Order 10096, |                   |      |   |     |   |             |
| as amended   |                   |      |   |     |   |             |
| by Executive |                   |      |   |     |   |             |
| Order 10930. |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
| c. I do not  |                   |      |   |     |   |             |
| desire to    |                   |      |   |     |   |             |
| give the     |                   |      |   |     |   |             |
| U.S.         |                   |      |   |     |   |             |
| Government   |                   |      |   |     |   |             |
| any rights   |                   |      |   |     |   |             |
| in and to    |                   |      |   |     |   |             |
| the          |                   |      |   |     |   |             |
| invention.   |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
| NOTE: Date   |                   |      |   |     |   |             |
| and sign her |                   |      |   |     |   |             |
| only if item |                   |      |   |     |   |             |
| 7a is        |                   |      |   |     |   |             |
| checked.     |                   |      |   |     |   |             |
+--------------+-------------------+------+---+-----+---+-------------+
| DATE         | SIGNATURE OR      |      |   | Se  |   |             |
|              | INVENTOR (or      |      |   | cur |   |             |
|              | co-inventor)      |      |   | ity |   |             |
|              |                   |      |   | cl  |   |             |
|              |                   |      |   | ass |   |             |
|              |                   |      |   | ifi |   |             |
|              |                   |      |   | cat |   |             |
|              |                   |      |   | ion |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
|              |                   |      |   |     |   |             |
+--------------+-------------------+------+---+-----+---+-------------+

+---+--------------------------+-----------------+----------------------+
| # |                          |                 |                      |
|   |                          |                 |                      |
| S |                          |                 |                      |
| E |                          |                 |                      |
| C |                          |                 |                      |
| T |                          |                 |                      |
| I |                          |                 |                      |
| O |                          |                 |                      |
| N |                          |                 |                      |
|   |                          |                 |                      |
| B |                          |                 |                      |
|   |                          |                 |                      |
| - |                          |                 |                      |
| - |                          |                 |                      |
|   |                          |                 |                      |
| M |                          |                 |                      |
| A |                          |                 |                      |
| K |                          |                 |                      |
| I |                          |                 |                      |
| N |                          |                 |                      |
| G |                          |                 |                      |
|   |                          |                 |                      |
| T |                          |                 |                      |
| H |                          |                 |                      |
| E |                          |                 |                      |
|   |                          |                 |                      |
| I |                          |                 |                      |
| N |                          |                 |                      |
| V |                          |                 |                      |
| E |                          |                 |                      |
| N |                          |                 |                      |
| T |                          |                 |                      |
| I |                          |                 |                      |
| O |                          |                 |                      |
| N |                          |                 |                      |
+---+--------------------------+-----------------+----------------------+
| N |                          |                 |                      |
| O |                          |                 |                      |
| T |                          |                 |                      |
| E |                          |                 |                      |
| : |                          |                 |                      |
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| p |                          |                 |                      |
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| t |                          |                 |                      |
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| o |                          |                 |                      |
| n |                          |                 |                      |
| o |                          |                 |                      |
| f |                          |                 |                      |
| m |                          |                 |                      |
| a |                          |                 |                      |
| t |                          |                 |                      |
| t |                          |                 |                      |
| e |                          |                 |                      |
| r |                          |                 |                      |
| . |                          |                 |                      |
+---+--------------------------+-----------------+----------------------+
| 1 | BEFORE THE INVENTION WAS |                 |                      |
| \ | PHYSICALLY TRIED OUT OR  |                 |                      |
| . | PRODUCED IN MODEL FORM   |                 |                      |
|   | OR A COMPOSITION OF      |                 |                      |
|   | MATTER PRODUCED, WERE    |                 |                      |
|   | THE ESSENTIAL ELEMENTS   |                 |                      |
|   | OF THE INVENTION IN ITS  |                 |                      |
|   | OPERABLE AND PRACTICABLE |                 |                      |
|   | FORM FULLY DISCLOSED IN  |                 |                      |
|   | WRITTEN DESCRIPTION,     |                 |                      |
|   | SKETCHES OR DRAWINGS IN  |                 |                      |
|   | SUCH A MANNER THAT THE   |                 |                      |
|   | INVENTION COULD BE       |                 |                      |
|   | PRODUCED OR PRACTICED    |                 |                      |
|   | FROM THEM WITHOUT THE    |                 |                      |
|   | EXERCISE OF ANY FURTHER  |                 |                      |
|   | INVENTIVE SKILL BY A     |                 |                      |
|   | PERSON WHO IS SKILLED IN |                 |                      |
|   | THE FIELD TO WHICH THE   |                 |                      |
|   | INVENTION RELATES? YES   |                 |                      |
|   | NO. IF THE ANSWER IS     |                 |                      |
|   | "YES", GIVE THE DATE     |                 |                      |
|   | SUCH DESCRIPTIONS,       |                 |                      |
|   | SKETCHES OR DRAWINGS     |                 |                      |
|   | WERE COMPLETED?          |                 |                      |
+---+--------------------------+-----------------+----------------------+
| 2 | WAS A FULL SCALE WORKING |                 |                      |
| \ | MODEL OR A PROTOTYPE OF  |                 |                      |
| . | THE INVENTION MADE: OR,  |                 |                      |
|   | IF THE INVENTION IS A    |                 |                      |
|   | PROCESS, WAS THE PROCESS |                 |                      |
|   | TRIED OUT: OR IF THE     |                 |                      |
|   | INVENTION IS A           |                 |                      |
|   | COMPOSITION OF MATTER,   |                 |                      |
|   | WAS A COMPOSITION        |                 |                      |
|   | PRODUCED? YES (State     |                 |                      |
|   | date       ) NO          |                 |                      |
+---+--------------------------+-----------------+----------------------+
| 3 | IF A MODEL OR PROTOTYPE  |                 |                      |
| \ | WAS MADE AND TESTED, A   |                 |                      |
| . | COMPOSITION PRODUCED OR  |                 |                      |
|   | A PROCESS CARRIED OUT,   |                 |                      |
|   | WAS IT DONE BECAUSE..    |                 |                      |
|   | (Check)                  |                 |                      |
|   |                          |                 |                      |
|   | A. IT WAS DESIRED TO     |                 |                      |
|   | TEST THE OPERABILITY OR  |                 |                      |
|   | PRACTICABILITY OF THE    |                 |                      |
|   | INVENTION YES NO         |                 |                      |
+---+--------------------------+-----------------+----------------------+
|   | B. IT WAS DESIRED TO     |                 |                      |
|   | TEST THE USEFULNESS OF   |                 |                      |
|   | THE INVENTION TO THE     |                 |                      |
|   | GOVERNMENT YES NO        |                 |                      |
+---+--------------------------+-----------------+----------------------+
|   | C. OTHER REASON          |                 |                      |
|   | (Explain)       YES NO   |                 |                      |
+---+--------------------------+-----------------+----------------------+
| 4 | APPROXIMATELY HOW MUCH   | OWN TIME        | GOVERNMENT TIME      |
| \ | TOTAL TIME WAS SPENT BY  | (Outside        | (Working hours       |
| . | YOU PERSONALLY IN MAKING | working hours)  | including paid       |
|   | THE INVENTION?           | IN HOURS        | overtime) IN HOURS   |
|   |                          |                 |                      |
|   |                          |                 |                      |
+---+--------------------------+-----------------+----------------------+
| 5 | EXPLAIN BRIEFLY THE USE, |                 |                      |
| \ | IF ANY, OF THE FOLLOWING |                 |                      |
| . | ITEMS IN CONNECTION WITH |                 |                      |
|   | THE MAKING OF THE        |                 |                      |
|   | INVENTION. (Note:        |                 |                      |
|   | Indicate whether such    |                 |                      |
|   | use occurred PRIOR or    |                 |                      |
|   | SUBSEQUENT to either     |                 |                      |
|   | your disclosing the      |                 |                      |
|   | invention within the     |                 |                      |
|   | definition of question 1 |                 |                      |
|   | above, or trying out or  |                 |                      |
|   | producing the invention  |                 |                      |
|   | within the definition of |                 |                      |
|   | question 2 above).       |                 |                      |
+---+--------------------------+-----------------+----------------------+
|   | A. THE USE OF GOVERNMENT |                 |                      |
|   | FACILITIES (Buildings    |                 |                      |
|   | such as, laboratories,   |                 |                      |
|   | shops, or office         |                 |                      |
|   | buildings, but not       |                 |                      |
|   | buildings such as        |                 |                      |
|   | barracks or recreation   |                 |                      |
|   | buildings).              |                 |                      |
|   |                          |                 |                      |
|   |                          |                 |                      |
+---+--------------------------+-----------------+----------------------+
|   | B. THE USE OF GOVERNMENT |                 |                      |
|   | EQUIPMENT (Such as       |                 |                      |
|   | instruments, tools or    |                 |                      |
|   | machinery).              |                 |                      |
|   |                          |                 |                      |
|   |                          |                 |                      |
+---+--------------------------+-----------------+----------------------+
|   | C. THE USE OF GOVERNMENT |                 |                      |
|   | MATERIALS (Supplies,     |                 |                      |
|   | reagents, parts, or any  |                 |                      |
|   | other materials; if      |                 |                      |
|   | scrap, waste, or salvage |                 |                      |
|   | materials were used, so  |                 |                      |
|   | state; give estimated    |                 |                      |
|   | monetary value of        |                 |                      |
|   | materials consumed).     |                 |                      |
|   |                          |                 |                      |
|   |                          |                 |                      |
+---+--------------------------+-----------------+----------------------+
|   | D. USE OF GOVERNMENT     |                 |                      |
|   | FUNDS (Other than        |                 |                      |
|   | salaries and wages, and  |                 |                      |
|   | Government contributions |                 |                      |
|   | covered under other      |                 |                      |
|   | parts of this question)  |                 |                      |
|   | WHICH WERE ACTUALLY      |                 |                      |
|   | OBLIGATED OR EXPENDED    |                 |                      |
|   | FOP THE PURPOSE OF       |                 |                      |
|   | MAKING INVENTION.        |                 |                      |
|   |                          |                 |                      |
|   |                          |                 |                      |
+---+--------------------------+-----------------+----------------------+
|   | E. CONTRIBUTION BY THE   |                 |                      |
|   | GOVERNMENT OF            |                 |                      |
|   | INFORMATION (Which was   |                 |                      |
|   | available to you by      |                 |                      |
|   | reason of your official  |                 |                      |
|   | duties and not           |                 |                      |
|   | otherwise).              |                 |                      |
|   |                          |                 |                      |
|   |                          |                 |                      |
+---+--------------------------+-----------------+----------------------+
|   | F. CONTRIBUTION OF TIME  |                 |                      |
|   | OR SERVICES OF OTHER     |                 |                      |
|   | GOVERNMENT EMPLOYEES     |                 |                      |
|   | DURING NORMAL OR         |                 |                      |
|   | OVERTIME WORKING HOURS   |                 |                      |
|   | (State approximate       |                 |                      |
|   | number of hours and type |                 |                      |
|   | of assistance).          |                 |                      |
|   |                          |                 |                      |
|   |                          |                 |                      |
+---+--------------------------+-----------------+----------------------+
| # |                          |                 |                      |
| # |                          |                 |                      |
| # |                          |                 |                      |
|   |                          |                 |                      |
| S |                          |                 |                      |
| E |                          |                 |                      |
| C |                          |                 |                      |
| T |                          |                 |                      |
| I |                          |                 |                      |
| O |                          |                 |                      |
| N |                          |                 |                      |
|   |                          |                 |                      |
| C |                          |                 |                      |
|   |                          |                 |                      |
| - |                          |                 |                      |
| - |                          |                 |                      |
|   |                          |                 |                      |
| R |                          |                 |                      |
| E |                          |                 |                      |
| L |                          |                 |                      |
| A |                          |                 |                      |
| T |                          |                 |                      |
| I |                          |                 |                      |
| O |                          |                 |                      |
| N |                          |                 |                      |
| S |                          |                 |                      |
| H |                          |                 |                      |
| I |                          |                 |                      |
| P |                          |                 |                      |
|   |                          |                 |                      |
| B |                          |                 |                      |
| E |                          |                 |                      |
| T |                          |                 |                      |
| W |                          |                 |                      |
| E |                          |                 |                      |
| E |                          |                 |                      |
| N |                          |                 |                      |
|   |                          |                 |                      |
| T |                          |                 |                      |
| H |                          |                 |                      |
| E |                          |                 |                      |
|   |                          |                 |                      |
| I |                          |                 |                      |
| N |                          |                 |                      |
| V |                          |                 |                      |
| E |                          |                 |                      |
| N |                          |                 |                      |
| T |                          |                 |                      |
| I |                          |                 |                      |
| O |                          |                 |                      |
| N |                          |                 |                      |
|   |                          |                 |                      |
| A |                          |                 |                      |
| N |                          |                 |                      |
| D |                          |                 |                      |
|   |                          |                 |                      |
| T |                          |                 |                      |
| H |                          |                 |                      |
| E |                          |                 |                      |
|   |                          |                 |                      |
| I |                          |                 |                      |
| N |                          |                 |                      |
| V |                          |                 |                      |
| E |                          |                 |                      |
| N |                          |                 |                      |
| T |                          |                 |                      |
| O |                          |                 |                      |
| R |                          |                 |                      |
| ' |                          |                 |                      |
| S |                          |                 |                      |
|   |                          |                 |                      |
| D |                          |                 |                      |
| U |                          |                 |                      |
| T |                          |                 |                      |
| I |                          |                 |                      |
| E |                          |                 |                      |
| S |                          |                 |                      |
+---+--------------------------+-----------------+----------------------+
| 1 | BRIEFLY, WHAT PROMPTED   |                 |                      |
| \ | YOU TO MAKE THE          |                 |                      |
| . | INVENTION: OR HOW DID    |                 |                      |
|   | YOU GET THE IDEA FOR THE |                 |                      |
|   | INVENTION?               |                 |                      |
|   |                          |                 |                      |
|   |                          |                 |                      |
+---+--------------------------+-----------------+----------------------+

+---+-----------+--------------------------------------------------------+
| 2 | BRIEFLY   |                                                        |
| \ | AND IN    |                                                        |
| . | BROAD     |                                                        |
|   | TERMS,    |                                                        |
|   | WHAT IS   |                                                        |
|   | THE       |                                                        |
|   | INVENTION |                                                        |
|   | SUPPOSED  |                                                        |
|   | TO        |                                                        |
|   | AC        |                                                        |
|   | COMPLISH? |                                                        |
|   |           |                                                        |
|   |           |                                                        |
+---+-----------+--------------------------------------------------------+
| 3 | WERE YOU  |                                                        |
| \ | EMPLOYED  |                                                        |
| . | OR        |                                                        |
|   | ASSIGNED  |                                                        |
|   | (Check    |                                                        |
|   | a         |                                                        |
|   | pplicable |                                                        |
|   | box(es):  |                                                        |
|   |           |                                                        |
|   | A. TO     |                                                        |
|   | INVENT OR |                                                        |
|   | IMPROVE   |                                                        |
|   | OR        |                                                        |
|   | PERFECT   |                                                        |
|   | ANY ART,  |                                                        |
|   | PROCESS,  |                                                        |
|   | MACHINE,  |                                                        |
|   | MAN       |                                                        |
|   | UFACTURE, |                                                        |
|   | DESIGN,   |                                                        |
|   | OR        |                                                        |
|   | CO        |                                                        |
|   | MPOSITION |                                                        |
|   | OF        |                                                        |
|   | MATTER?   |                                                        |
|   | YES NO    |                                                        |
+---+-----------+--------------------------------------------------------+
|   | B. TO     |                                                        |
|   | CONDUCT   |                                                        |
|   | OR        |                                                        |
|   | PERFORM   |                                                        |
|   | RESEARCH  |                                                        |
|   | OR        |                                                        |
|   | DE        |                                                        |
|   | VELOPMENT |                                                        |
|   | WORK? YES |                                                        |
|   | NO        |                                                        |
+---+-----------+--------------------------------------------------------+
|   | C. TO     |                                                        |
|   | S         |                                                        |
|   | UPERVISE, |                                                        |
|   | DIRECT,   |                                                        |
|   | CO        |                                                        |
|   | ORDINATE, |                                                        |
|   | OR REVIEW |                                                        |
|   | G         |                                                        |
|   | OVERNMENT |                                                        |
|   | -FINANCED |                                                        |
|   | OR        |                                                        |
|   | CONDUCTED |                                                        |
|   | RESEARCH  |                                                        |
|   | OR        |                                                        |
|   | DE        |                                                        |
|   | VELOPMENT |                                                        |
|   | WORK? YES |                                                        |
|   | NO        |                                                        |
+---+-----------+--------------------------------------------------------+
|   | D. TO ACT |                                                        |
|   | IN A      |                                                        |
|   | LIAISON   |                                                        |
|   | CAPACITY  |                                                        |
|   | AMONG     |                                                        |
|   | G         |                                                        |
|   | OVERNMENT |                                                        |
|   | OR        |                                                        |
|   | NON-GOV   |                                                        |
|   | ERNMENTAL |                                                        |
|   | AGENCIES  |                                                        |
|   | OR        |                                                        |
|   | IN        |                                                        |
|   | DIVIDUALS |                                                        |
|   | ENGAGED   |                                                        |
|   | IN SUCH   |                                                        |
|   | RESEARCH  |                                                        |
|   | OR        |                                                        |
|   | DE        |                                                        |
|   | VELOPMENT |                                                        |
|   | WORK? YES |                                                        |
|   | NO        |                                                        |
+---+-----------+--------------------------------------------------------+
| 4 | DESCRIBE  |                                                        |
| \ | THE       |                                                        |
| . | DUTIES,   |                                                        |
|   | PROJECT,  |                                                        |
|   | OR AREA   |                                                        |
|   | OF WORK   |                                                        |
|   | TO WHICH  |                                                        |
|   | YOU WERE  |                                                        |
|   | ASSIGNED  |                                                        |
|   | AT THE    |                                                        |
|   | TIME THE  |                                                        |
|   | INVENTION |                                                        |
|   | WAS MADE. |                                                        |
|   | (State in |                                                        |
|   | s         |                                                        |
|   | ufficient |                                                        |
|   | detail to |                                                        |
|   | make them |                                                        |
|   | underst   |                                                        |
|   | andable.) |                                                        |
|   |           |                                                        |
|   |           |                                                        |
+---+-----------+--------------------------------------------------------+
| 5 | DO YOU    |                                                        |
| \ | FEEL THAT |                                                        |
| . | THE       |                                                        |
|   | INVENTION |                                                        |
|   | IS        |                                                        |
|   | DIRECTLY  |                                                        |
|   | RELATED   |                                                        |
|   | TO YOUR   |                                                        |
|   | WORK? YES |                                                        |
|   | NO        |                                                        |
|   |           |                                                        |
|   | (Briefly  |                                                        |
|   | state     |                                                        |
|   | your      |                                                        |
|   | reasons)  |                                                        |
|   |           |                                                        |
|   |           |                                                        |
+---+-----------+--------------------------------------------------------+
| 6 | DOES THE  |                                                        |
| \ | INVENTION |                                                        |
| . | SOLVE A   |                                                        |
|   | PROBLEM   |                                                        |
|   | WHICH IN  |                                                        |
|   | THE       |                                                        |
|   | CIRC      |                                                        |
|   | UMSTANCES |                                                        |
|   | OF YOUR   |                                                        |
|   | DUTIES    |                                                        |
|   | YOU COULD |                                                        |
|   | R         |                                                        |
|   | EASONABLY |                                                        |
|   | HAVE BEEN |                                                        |
|   | EXPECTED  |                                                        |
|   | TO SOLVE? |                                                        |
|   | YES NO    |                                                        |
|   | (Briefly  |                                                        |
|   | state     |                                                        |
|   | your      |                                                        |
|   | reasons)  |                                                        |
|   |           |                                                        |
|   |           |                                                        |
+---+-----------+--------------------------------------------------------+
| 7 | A. WERE   |                                                        |
| \ | YOU       |                                                        |
| . | INVOLVED  |                                                        |
|   | IN BASIC  |                                                        |
|   | RESEARCH? |                                                        |
|   | YES       |                                                        |
|   | (State    |                                                        |
|   | briefly   |                                                        |
|   | to what   |                                                        |
|   | extent)   |                                                        |
|   | NO        |                                                        |
|   |           |                                                        |
|   |           |                                                        |
+---+-----------+--------------------------------------------------------+
|   | B. WAS    |                                                        |
|   | THE       |                                                        |
|   | INVENTION |                                                        |
|   | SUGGESTED |                                                        |
|   | BY THE    |                                                        |
|   | WORK      |                                                        |
|   | PERFORMED |                                                        |
|   | IN THE    |                                                        |
|   | BASIC     |                                                        |
|   | RESEARCH? |                                                        |
|   |           |                                                        |
|   | YES       |                                                        |
|   | (explain) |                                                        |
|   | NO        |                                                        |
|   |           |                                                        |
|   |           |                                                        |
+---+-----------+--------------------------------------------------------+
| 8 | STATE ANY |                                                        |
| \ | FACTS NOT |                                                        |
| . | COVERED   |                                                        |
|   | IN ABOVE  |                                                        |
|   | ANSWERS   |                                                        |
|   | WHICH     |                                                        |
|   | WILL HAVE |                                                        |
|   | A BEARING |                                                        |
|   | ON EITHER |                                                        |
|   | THE       |                                                        |
|   | GOV       |                                                        |
|   | ERNMENT'S |                                                        |
|   | OR YOUR   |                                                        |
|   | RIGHTS IN |                                                        |
|   | THE       |                                                        |
|   | I         |                                                        |
|   | NVENTION. |                                                        |
|   |           |                                                        |
|   |           |                                                        |
+---+-----------+--------------------------------------------------------+
| # |           |                                                        |
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+---+-----------+--------------------------------------------------------+
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+---+-----------+--------------------------------------------------------+
| D |           | SIGNATURE OF INVENTOR                                  |
| A |           |                                                        |
| T |           |                                                        |
| E |           |                                                        |
|   |           |                                                        |
|   |           |                                                        |
|   |           |                                                        |
|   |           |                                                        |
|   |           |                                                        |
|   |           |                                                        |
+---+-----------+--------------------------------------------------------+

+---+-----------+---------+---------+---+-----------+-----------------+
| # |           |         |         |   |           |                 |
| # |           |         |         |   |           |                 |
| # |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
| S |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| C |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| I |           |         |         |   |           |                 |
| O |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
| - |           |         |         |   |           |                 |
| - |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
| S |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| A |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| M |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
| O |           |         |         |   |           |                 |
| F |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
| I |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
| V |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| O |           |         |         |   |           |                 |
| R |           |         |         |   |           |                 |
| ' |           |         |         |   |           |                 |
| S |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
| S |           |         |         |   |           |                 |
| U |           |         |         |   |           |                 |
| P |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| R |           |         |         |   |           |                 |
| V |           |         |         |   |           |                 |
| I |           |         |         |   |           |                 |
| S |           |         |         |   |           |                 |
| O |           |         |         |   |           |                 |
| R |           |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
| 1 | WAS THE   |         |         |   |           |                 |
| \ | INVENTION |         |         |   |           |                 |
| . | THE SET   |         |         |   |           |                 |
|   | GOAL OF A |         |         |   |           |                 |
|   | SPECIFIC  |         |         |   |           |                 |
|   | TASK      |         |         |   |           |                 |
|   | ASSIGNED  |         |         |   |           |                 |
|   | TO THE    |         |         |   |           |                 |
|   | INVENTOR? |         |         |   |           |                 |
|   | YES NO    |         |         |   |           |                 |
|   | (If YES,  |         |         |   |           |                 |
|   | answer to |         |         |   |           |                 |
|   | items 2   |         |         |   |           |                 |
|   | and 3 not |         |         |   |           |                 |
|   | required) |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
| 2 | A. AT THE |         |         |   |           |                 |
| \ | TIME THE  |         |         |   |           |                 |
| . | INVENTION |         |         |   |           |                 |
|   | WAS MADE, |         |         |   |           |                 |
|   | WHAT      |         |         |   |           |                 |
|   | CONTACT   |         |         |   |           |                 |
|   | DID YOU   |         |         |   |           |                 |
|   | HAVE WITH |         |         |   |           |                 |
|   | THE       |         |         |   |           |                 |
|   | INVENTOR  |         |         |   |           |                 |
|   | AND TO    |         |         |   |           |                 |
|   | WHAT      |         |         |   |           |                 |
|   | EXTENT    |         |         |   |           |                 |
|   | DID YOU   |         |         |   |           |                 |
|   | HAVE      |         |         |   |           |                 |
|   | ACTUAL    |         |         |   |           |                 |
|   | PERSONAL  |         |         |   |           |                 |
|   | KNOWLEDGE |         |         |   |           |                 |
|   | OF THE    |         |         |   |           |                 |
|   | I         |         |         |   |           |                 |
|   | NVENTOR'S |         |         |   |           |                 |
|   | DUTIES    |         |         |   |           |                 |
|   | AND THE   |         |         |   |           |                 |
|   | SUBSTANCE |         |         |   |           |                 |
|   | OF HIS    |         |         |   |           |                 |
|   | I         |         |         |   |           |                 |
|   | NVENTION? |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
|   | B. AT THE |         | \(1\)   |   |           |                 |
|   | TIME THE  |         | WOULD   |   |           |                 |
|   | INVENTION |         | HE HAVE |   |           |                 |
|   | WAS MADE: |         | TO      |   |           |                 |
|   |           |         | OBTAIN  |   |           |                 |
|   |           |         | THE     |   |           |                 |
|   |           |         | A       |   |           |                 |
|   |           |         | PPROVAL |   |           |                 |
|   |           |         | OF HIS  |   |           |                 |
|   |           |         | SU      |   |           |                 |
|   |           |         | PERIORS |   |           |                 |
|   |           |         | TO      |   |           |                 |
|   |           |         | C       |   |           |                 |
|   |           |         | ONTINUE |   |           |                 |
|   |           |         | DEVE    |   |           |                 |
|   |           |         | LOPMENT |   |           |                 |
|   |           |         | WORK ON |   |           |                 |
|   |           |         | IT AS A |   |           |                 |
|   |           |         | GOV     |   |           |                 |
|   |           |         | ERNMENT |   |           |                 |
|   |           |         | PROJECT |   |           |                 |
|   |           |         | OR DUTY |   |           |                 |
|   |           |         | ASSI    |   |           |                 |
|   |           |         | GNMENT? |   |           |                 |
|   |           |         | YES NO  |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
|   |           |         | \(2\)   |   |           |                 |
|   |           |         | COULD   |   |           |                 |
|   |           |         | HE      |   |           |                 |
|   |           |         | PROCEED |   |           |                 |
|   |           |         | UNDER   |   |           |                 |
|   |           |         | HIS OWN |   |           |                 |
|   |           |         | AUT     |   |           |                 |
|   |           |         | HORITY? |   |           |                 |
|   |           |         | YES NO  |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
|   |           |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
| 3 | AT THE    |         |         |   |           |                 |
| \ | TIME THE  |         |         |   |           |                 |
| . | INVENTION |         |         |   |           |                 |
|   | WAS MADE, |         |         |   |           |                 |
|   | WHAT WERE |         |         |   |           |                 |
|   | THE       |         |         |   |           |                 |
|   | OFFICIAL  |         |         |   |           |                 |
|   | DUTIES OF |         |         |   |           |                 |
|   | THE       |         |         |   |           |                 |
|   | INVENTOR? |         |         |   |           |                 |
|   | (State in |         |         |   |           |                 |
|   | s         |         |         |   |           |                 |
|   | ufficient |         |         |   |           |                 |
|   | detail to |         |         |   |           |                 |
|   | make his  |         |         |   |           |                 |
|   | duties    |         |         |   |           |                 |
|   | unders    |         |         |   |           |                 |
|   | tandable. |         |         |   |           |                 |
|   | If in     |         |         |   |           |                 |
|   | doubt,    |         |         |   |           |                 |
|   | submit a  |         |         |   |           |                 |
|   | copy of   |         |         |   |           |                 |
|   | his job   |         |         |   |           |                 |
|   | de        |         |         |   |           |                 |
|   | scription |         |         |   |           |                 |
|   | or so     |         |         |   |           |                 |
|   | much of   |         |         |   |           |                 |
|   | it as     |         |         |   |           |                 |
|   | sets      |         |         |   |           |                 |
|   | forth the |         |         |   |           |                 |
|   | pertinent |         |         |   |           |                 |
|   | duties.   |         |         |   |           |                 |
|   | If        |         |         |   |           |                 |
|   | a         |         |         |   |           |                 |
|   | dequately |         |         |   |           |                 |
|   | described |         |         |   |           |                 |
|   | in item 4 |         |         |   |           |                 |
|   | of        |         |         |   |           |                 |
|   | Section   |         |         |   |           |                 |
|   | C, state  |         |         |   |           |                 |
|   | so.)      |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
| 4 | A. AT THE |         |         |   |           |                 |
| \ | TIME THE  |         |         |   |           |                 |
| . | INVENTION |         |         |   |           |                 |
|   | WAS MADE  |         |         |   |           |                 |
|   | WHAT WERE |         |         |   |           |                 |
|   | THE       |         |         |   |           |                 |
|   | SPECIFIC  |         |         |   |           |                 |
|   | JOB OR    |         |         |   |           |                 |
|   | PROJECT   |         |         |   |           |                 |
|   | AS        |         |         |   |           |                 |
|   | SIGNMENTS |         |         |   |           |                 |
|   | OF THE    |         |         |   |           |                 |
|   | INVENTOR  |         |         |   |           |                 |
|   | WHICH     |         |         |   |           |                 |
|   | RELATED   |         |         |   |           |                 |
|   | TO THE    |         |         |   |           |                 |
|   | INVENTION |         |         |   |           |                 |
|   | AND WHAT  |         |         |   |           |                 |
|   | WERE THEY |         |         |   |           |                 |
|   | INTENDED  |         |         |   |           |                 |
|   | TO        |         |         |   |           |                 |
|   | AC        |         |         |   |           |                 |
|   | COMPLISH? |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
|   | B. AT THE |         |         |   |           |                 |
|   | TIME THE  |         |         |   |           |                 |
|   | INVENTION |         |         |   |           |                 |
|   | WAS MADE  |         |         |   |           |                 |
|   | COULD THE |         |         |   |           |                 |
|   | INVENTION |         |         |   |           |                 |
|   | R         |         |         |   |           |                 |
|   | EASONABLY |         |         |   |           |                 |
|   | HAVE BEEN |         |         |   |           |                 |
|   | EXPECTED  |         |         |   |           |                 |
|   | TO ARISE  |         |         |   |           |                 |
|   | FROM THE  |         |         |   |           |                 |
|   | DUTIES OF |         |         |   |           |                 |
|   | THE       |         |         |   |           |                 |
|   | INVENTOR? |         |         |   |           |                 |
|   | YES NO    |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
| 5 | TO THE    |         |         |   | \(1\)     |                 |
| \ | BEST OF   |         |         |   | DIRECTLY  |                 |
| . | YOUR      |         |         |   | RELATED   |                 |
|   | ABILITY,  |         |         |   | YES NO    |                 |
|   | HOW WOULD |         |         |   |           |                 |
|   | YOU       |         |         |   |           |                 |
|   | DESCRIBE  |         |         |   |           |                 |
|   | THE       |         |         |   |           |                 |
|   | REL       |         |         |   |           |                 |
|   | ATIONSHIP |         |         |   |           |                 |
|   | BETWEEN   |         |         |   |           |                 |
|   | THE       |         |         |   |           |                 |
|   | INVENTION |         |         |   |           |                 |
|   | AND THE   |         |         |   |           |                 |
|   | I         |         |         |   |           |                 |
|   | NVENTOR'S |         |         |   |           |                 |
|   | SPECIFIC  |         |         |   |           |                 |
|   | JOB OR    |         |         |   |           |                 |
|   | PROJECT   |         |         |   |           |                 |
|   | A         |         |         |   |           |                 |
|   | SSIGNMENT |         |         |   |           |                 |
|   | MOST      |         |         |   |           |                 |
|   | CLOSELY   |         |         |   |           |                 |
|   | RELATED   |         |         |   |           |                 |
|   | TO THE    |         |         |   |           |                 |
|   | INVENTION |         |         |   |           |                 |
|   | AT THE    |         |         |   |           |                 |
|   | TIME IT   |         |         |   |           |                 |
|   | WAS MADE? |         |         |   |           |                 |
|   | (Check    |         |         |   |           |                 |
|   | one only) |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
|   |           |         |         |   | \(2\)     |                 |
|   |           |         |         |   | RELATED,  |                 |
|   |           |         |         |   | BUT NOT   |                 |
|   |           |         |         |   | DIRECTLY  |                 |
|   |           |         |         |   | YES NO    |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
|   |           |         |         |   | \(3\)     |                 |
|   |           |         |         |   | UNRELATED |                 |
|   |           |         |         |   | YES NO    |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
| # | ###       |         |         |   |           |                 |
| # | DO YOU AG |         |         |   |           |                 |
| # | REE WITH  |         |         |   |           |                 |
|   | THE REPLI |         |         |   |           |                 |
| 6 | ES WHICH  |         |         |   |           |                 |
| . | THE INVEN |         |         |   |           |                 |
|   | TOR MADE  |         |         |   |           |                 |
|   | TO EACH O |         |         |   |           |                 |
|   | F THE SEC |         |         |   |           |                 |
|   | TIONS A T |         |         |   |           |                 |
|   | HROUGH C? |         |         |   |           |                 |
|   |  (If the  |         |         |   |           |                 |
|   | answer is |         |         |   |           |                 |
|   |  "NO" com |         |         |   |           |                 |
|   | ment on t |         |         |   |           |                 |
|   | hose stat |         |         |   |           |                 |
|   | ements or |         |         |   |           |                 |
|   |  answers  |         |         |   |           |                 |
|   | deemed im |         |         |   |           |                 |
|   | proper on |         |         |   |           |                 |
|   |  a separa |         |         |   |           |                 |
|   | te sheet. |         |         |   |           |                 |
|   |  Sign and |         |         |   |           |                 |
|   |  attach.) |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   | YES NO    |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
| # |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
| C |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| R |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| I |           |         |         |   |           |                 |
| F |           |         |         |   |           |                 |
| I |           |         |         |   |           |                 |
| C |           |         |         |   |           |                 |
| A |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| I |           |         |         |   |           |                 |
| O |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
| O |           |         |         |   |           |                 |
| F |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
| S |           |         |         |   |           |                 |
| U |           |         |         |   |           |                 |
| P |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| R |           |         |         |   |           |                 |
| V |           |         |         |   |           |                 |
| I |           |         |         |   |           |                 |
| S |           |         |         |   |           |                 |
| O |           |         |         |   |           |                 |
| R |           |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
| I |           |         |         |   |           |                 |
| C |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| R |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| I |           |         |         |   |           |                 |
| F |           |         |         |   |           |                 |
| Y |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| H |           |         |         |   |           |                 |
| A |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| H |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| F |           |         |         |   |           |                 |
| O |           |         |         |   |           |                 |
| R |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| G |           |         |         |   |           |                 |
| O |           |         |         |   |           |                 |
| I |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
| G |           |         |         |   |           |                 |
| I |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
| F |           |         |         |   |           |                 |
| O |           |         |         |   |           |                 |
| R |           |         |         |   |           |                 |
| M |           |         |         |   |           |                 |
| A |           |         |         |   |           |                 |
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| A |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
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| M |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
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| D |           |         |         |   |           |                 |
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| S |           |         |         |   |           |                 |
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| T |           |         |         |   |           |                 |
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| H |           |         |         |   |           |                 |
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| B |           |         |         |   |           |                 |
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| S |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
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| F |           |         |         |   |           |                 |
| M |           |         |         |   |           |                 |
| Y |           |         |         |   |           |                 |
| K |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
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| W |           |         |         |   |           |                 |
| L |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| D |           |         |         |   |           |                 |
| G |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| A |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
| D |           |         |         |   |           |                 |
| B |           |         |         |   |           |                 |
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| L |           |         |         |   |           |                 |
| I |           |         |         |   |           |                 |
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| F |           |         |         |   |           |                 |
| . |           |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
| D |           | JOB     |         |   |           |                 |
| A |           | TITLE   |         |   |           |                 |
| T |           | AT TIME |         |   |           |                 |
| E |           | IN      |         |   |           |                 |
|   |           | VENTION |         |   |           |                 |
|   |           | WAS     |         |   |           |                 |
|   |           | MADE    |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
| P |           |         |         |   |           |                 |
| R |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| S |           |         |         |   |           |                 |
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| N |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| D |           |         |         |   |           |                 |
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| T |           |         |         |   |           |                 |
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| T |           |         |         |   |           |                 |
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| L |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| P |           |         |         |   |           |                 |
| H |           |         |         |   |           |                 |
| O |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| A |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
| D |           |         |         |   |           |                 |
| A |           |         |         |   |           |                 |
| D |           |         |         |   |           |                 |
| D |           |         |         |   |           |                 |
| R |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| S |           |         |         |   |           |                 |
| S |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+
| T |           |         |         | S |           |                 |
| Y |           |         |         | I |           |                 |
| P |           |         |         | G |           |                 |
| E |           |         |         | N |           |                 |
| D |           |         |         | A |           |                 |
| O |           |         |         | T |           |                 |
| R |           |         |         | U |           |                 |
| P |           |         |         | R |           |                 |
| R |           |         |         | E |           |                 |
| I |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
| T |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
| D |           |         |         |   |           |                 |
| N |           |         |         |   |           |                 |
| A |           |         |         |   |           |                 |
| M |           |         |         |   |           |                 |
| E |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
|   |           |         |         |   |           |                 |
+---+-----------+---------+---------+---+-----------+-----------------+

(Security Classification)