Terminal Disclaimer to Accompany Petition under 37 CFR 1.137 in a Design Application Filed on or after September 16, 2012

• Legal Form Number: AIA/63
• Court: United States Patent and Trademark Office
• Section: United States Patent and Trademark Office

PTO/AIA/63 (07-16)

Approved for use through 11/30/2027. OMB 0651-0031

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

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TERMINAL DISCLAIMER TO ACCOMPANY PETITION

UNDER 37 CFR 1.137 IN A DESIGN APPLICATION

FILED ON OR AFTER SEPTEMBER 16, 2012

Docket Number (Optional)

Applicant:

First named inventor:

Application No.:

Filed:

For:

The applicant, _____________________________________________, owner of __________ percent interest in the instant design

application, hereby disclaims a terminal part of the statutory term of any patent granted on the instant design application equivalent to the

period of abandonment of the instant design application. This disclaimer also applies to any patent granted on a continuing design

application that contains a specific reference under 35 U.S.C. 120, 121, 365(c), or 386(c) to the instant design application. This disclaimer

is binding upon the grantee, and its successors or assigns.

Check either box 1 or 2 below, if appropriate.

I hereby acknowledge that any willful false statements made are punishable under 18 U.S.C. 1001 by fine or imprisonment of not more

than five (5) years, or both.

1. The undersigned is the applicant. If the applicant is an assignee, the undersigned is authorized to act on behalf of the assignee.

2. The undersigned is an attorney or agent of record. Reg. No. _______________

__________________________________________________________ __________________________________

Signature Date

__________________________________________________________ __________________________________

Typed or printed name Telephone number

_______________________________________________________________________________________________

Title

The terminal disclaimer fee under 37 CFR 1.20(d) is included.

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