Doc code: Oath
Document Description: Oath or declaration filed

PTO/$,$ (06-15)
Approved for use through 05/31/2024. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.

SUBSTITUTE STATEMENT IN LIEU OF AN OATH OR DECLARATION FOR UTILITY
OR DESIGN PATENT APPLICATION (35 U.S.C. 115(d) AND 37 CFR 1.64)
Title ofInvention

This statement is directed to:
The attached application,

OR
United States application or PCT international application number ____________________ filed on ___________________.

LEGAL NAME of inventor to whom this substitute statement applies:(E.g., Given Name (first and middle (if any)) and Family Name or Surname)Residence (except for a deceased or legally incapacitated inventor):
City

State

Country

Mailing Address (except for a deceased or legally incapacitated inventor):

City

Zip

State

Country

I believe the above-named inventor or joint inventor to be the original inventor or an original joint inventor of a claimed invention
in the application.
The above-identified application was made or authorized to be made by me.
I hereby acknowledge that any willful false statement made in this statement is punishable under 18 U.S.C. 1001 by fine or
imprisonment of not more than five (5) years, or both.

Relationship to the inventor to whom this substitute statement applies:
Legal Representative (for deceased or legally incapacitated inventor only),
Assignee,
Person to whom the inventor is under an obligation to assign,
Person who otherwise shows a sufficient proprietary interest in the matter (petition under 37 CFR 1.46 is required), orJoint Inventor.
[Page 1 of 2]
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If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

PTO/SB/$,$ (06-15)
Approved for use through 05/31/2024. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.

SUBSTITUTE STATEMENT&LUFXPVWDQFHV SHUPLWWLQJH[HFXWLRQRIWKLVVXEVWLWXWHVWDWHPHQWInventor is deceased,Inventor is under legal incapacity,Inventor cannot be found or reached after diligent effort, orInventor has refused to execute the oath or declaration under 37 CFR 1.63.
If there are joint inventors, please check the appropriate box below:
An application data sheet under 37 CFR 1.76 (PTO/$,$/14 or equivalent) naming the entire inventive entity has beenor is currently submitted.

ORAn application data sheet under 37 CFR 1.76 (PTO/$,$/14 or equivalent) has not been submitted. Thus, a SubstituteStatement Supplemental Sheet (PTO/$,$ or equivalent) naming the entire inventive entity and providing inventor
information is attached. See 37 CFR 1.64(b).

WARNING:
Petitioner/applicant is cautioned to avoid submitting personal information in documents filed in a patent application that may
contribute to identity theft. Personal information such as social security numbers, bank account numbers, or credit card numbers(other than a check or credit card authorization form PTO-2038 submitted for payment purposes) is never required by the USPTO
to support a petition or an application. If this type of personal information is included in documents submitted to the USPTO,petitioners/applicants should consider redacting such personal information from the documents before submitting them to theUSPTO. Petitioner/applicant is advised that the record of a patent application is available to the public after publication of theapplication (unless a non-publication request in compliance with 37 CFR 1.213(a) is made in the application) or issuance of apatent. Furthermore, the record from an abandoned application may also be available to the public if the application isreferenced in a published application or an issued patent (see 37 CFR 1.14). Checks and credit card authorization forms
PTO-2038 submitted for payment purposes are not retained in the application file and therefore are not publicly available.
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Signature:$33/,&$171$0($1'7,7/(2)3(5621EXECUTING THIS SUBSTITUTE STATEMENT:,IWKHDSSOLFDQWLVDMXULVWLFHQWLW\OLVWWKHDSSOLFDQWQDPHDQGWKHWLWOHRIWKHVLJQHU:$SSOLFDQW1DPH:
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>Page 2 of 2]

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