(a) 

(b) 

(d) 

e 

> 

REF ID:A678086 

R:CORD OF MILrTAnY IN~111'ION 

w~R DEi'Atfl'l~NT 

Office of the Chief of Air Service 

Patents Section 

Munitions Building, \'lashingt.on, D. C. 

(Use separate sheet for each invention) 

~cw INSTRUCTIONS ON BACK 

Dates and places of In•·ention. 

(1) Conc.eption by invento~· Etme lS, :j?$ at _ _... .._11..._ __ ....,..._, ,. ~ 1\ tz:_ t::J!i? .... U• 

(2) Disclosure to others._ T.o:e _________ at ______ _ 

(3) First sketch or drawing:J·a.,e f:.:1 !.;;33 at ·- ~ r -

' :x• ... ' h-.i!J.., 

( 4) First written descr1pt1on: . ..,;; ...__.......,,....:;•.;;io:;i~'"9'---at um• .... , .; 

(5) Completion of model 

.. , ... , "" ...... . 

or full sized dev1ce·-i;;r-t~~~-=-a----------at. _________ _ 

(6) First tast or operation of invention ,_.--~ ...... -------------at.,_. ______ _ !i .nt .. 

(e) Results of tests, and 

extent of use of invention: 

( t) Names of persons having knowledge 

of facts stated under (d) and (e): 

(g) Prior Reports: Ihnc.. 

(h) Patents and Patent applieations: {.C)U<$ oL~i-:· ~~:.·i ~lw"l .. "lt ~,PPlicatiol). 

(i) Rights of U .S.Goverment: U.:J;~l l.::.~ .. "l.:;;, 

( j) Licenses o:r Assignment: 1a ... m~. 

(k) Contracts involved: 

Contract ors 

Contract No. and date 

Subject matter 

Location of Plant 

Official title or 

status of employment 

of invent or: 

(1) Signature of witness and date: 

(m) Remarks of Forwarding Officer: 

Address 

Type of Contra.et 

Signature of Forwarding Of f1cer 

and date: 

roved for Release b NSA on 09-05-2013 ursuantto E .0. 1352 

Over W-892,A.S. Rev.6/2/24 
(a) 

(b) 

{c) 

(d) 

{e) 

• ~ 

The f ollo'fl.ng information will Le gi1en under t.1"'3 hecldinr;s ::i:.ndicated· 

The inventor should give hlb pJrm.:i.nent address Fe should also give 

his rank, corps, position or suatus of employment at tne t~me invention was made. 

The title of tne i~ve~tion should start with Nords inaicat1n~ the Q 

class to v.ihich the 1nvention belo11gs, swell as "llJothod of" or 

''Precess of 11 1n ca~e the invention r1;1lci'l.es to a r.1etnod or process, 

or ~ .. he nai .. e e,,f ~he article, device or t1pe of •iachine in cese the 

invention re~ates to dJl article, devica er machine, or the na~e 

of the material or composition in case the invention is an lQproveraent in m.J.terial or composition. 

The descript:.on of the invention i.iay be brief, provided reference 

is mado to detailed spec1ficat1ons and dra.11ngs, which should be 

identified by dato and f1le number i1 oificial, or should oe 

attached to tha report if not part of the oi'f ici.il ri..cords of tnc 

War Department. I~ either case, all drawings and degcriptiva 

pamphlets rejating to the invention ohould be listed. 

Care should be taken to oive the ~arliest date oa vni.ch the invention sug3ested itself to you, even tho~gh it was not coFpletely in 

mind. If t!1e invention co-1puses differe:1t invent.i.ve 1C:.ea&, sive 

the date3 with referencaJto each part o! t~e invnnt~on se,arately 1 

taking care to idertify each part clearly in the description of 

the invention. 

State whether 

the degree of 

sized device. 

separate "use 

or ~ot the invention ·~as found t.o oe operative, and 

success attained at e3ch test of the model or full 

I'l stating t~e Pxtent of use of the invention, 

by the Governr.ient" fror "co1I1Jr1.ercial uoe". 

(r) State the aa.meCJ of pa1 sons \,no haa kno.,1l ed.:;e c,f the invention 

and tacts concerning it on or about ~he da~eo mentioned. 

(g) Has description o; invention or report of test, if an/, been submitted to o!ficers of the dar Dep&.rtme'lt' If so, when ana to whom' 

Give references to ~11 prior repor~s, inclua1nB ~11 iafornation 

needed to locate same in files. 

(h) List all ap1llications for paten1ts by f'illni:, datea, b'0rial nUi.iber 

and title. List dll patents ~y patent nu~ber, date of erart, and titl~. 

(1) Has tender to the United States been iuade' If so, when a1'J.d to \whom' 

If not, tender the usp of the invention to tne Urited States or 

explain why not. 

(J) State what, if any, rights in tha i~ver.~ion~bave been granted to 

others, inc:luding extent or i.1terest granted and date of recording 

ass1gnirent or licerte in Patent Off ice. 

{k) If contracts have been placed !or the invention, or if the 1nventi.on was made in connection with the perforr.iance of a contract in 

which the United States is interested, ~he facts shoula be g1van 

briefly, 1ncludin~ contractor's name and address, Cortract No. and 

Date of Contract, SuoJect Matter, Location of Contractor's Plant 

where work was done, and Official Title or Status of Employm~nt of 

Inventor. 

(1) It 1s desirable that the witness be fa.Luliar w1tn tne facts stated 

concerning the invention and have a sufficient understanding of tne 

invention to describe its construct1~n and operation. 

(M) The forwarding officer should give his opinion of t~a value of the 

inventJ.011 to the u.s. and whether or not t.'1.e pro..lpective develo~'lme~t or the art t~ whach t~e 1nvention°relatos would make it advisable 

to protect the invantion and the Gcvor.'lfJlE>,'lt 1 s right to use tne s,~me 

by an application for ~atent. 

NS-3680/lvt'B -2- W-832, A.~.