Disclaimer in a Patent under 37 CFR 1.321(a)

• Legal Form Number: SB/43
• Court: United States Patent and Trademark Office, Patent Trial and Appeal Board
• Section: United States Patent and Trademark Office

Doc Code: STAT.DISCLMR

Document Description: Statutory Disclaimers per Manual of Patent Examining Procedure(MPEP) 1490 PTO/SB/43 (06-23)

Approved for use through 05/31 /2024. OMB 0651-0031

U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE

Under the Paperwork R eduction Act of 1995, no persons are required to respond to a collectio n of information unless it displays a valid OMB c ontrol number.

DISCLAIMER IN A PATENT UNDER 37 CFR 1.321(a)

Name of Patentee

Docket Number (optional)

Patent Number

Date Patent Issued

Title of Invention

Patentee hereby disclaims:

☐ the following complete claim(s) in the above-identi fied patent: ___________________________ ___.

☐ the terminal part of the term o f the above-identified patent beginning on the date: ______________.

☐ the entire term of the above-identified patent.

The disclaimer is binding on the patentee and its successors or assigns.

The extent of patentee’s ownership interest in the above-identified patent is : ___________________________.

The fee for this disclaimer is s et forth in 37 CFR 1.20(d) and is being paid in the following manner:

☐ payment by the USPTO’s patent electronic filing system (Patent Center or EFS-Web).

☐ the Director is hereby authorized to charge any fees which may be required, or credit any

overpayment, to Deposit Account No. _________________ _.

☐ payment by credit card. Form PTO-2038 is attached.

☐ a check in the amount of the fee is enclosed.

WARNING: Information on this form may become public. Credit card information should not be included on this

form. Provide credit card information and authorization on form PTO-2038.

The undersigned is:

☐ patentee. If patentee is a juristic entity, the undersigned is authorized to act on behalf of the juristic

entity.

☐ attorney or agent of record.

Signature

Date

Name (printed/typed)

Practitioner registration number

Note: See 37 CFR 1.4(d) for signature requirements and certifications.

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FORMS TO THIS ADDRESS. If filing the completed form by mail, send to: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.

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