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`Approved for use through 01/81/2013. OMB USSiv-GGS“:
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`DARTMENT ”VF COMMERCE
`US "rent and Trademark Olli ‘
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`STATEMENT UNQER 3? CFR 3.?3gci
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`Applicant/Patent Owner: Theranosinc_____________________________________________________________________________________________________________________________________________________________________________
`53/355,458
`Fiied/lssue Date: 3/26/2032
`Application NoJPatent No.1 _________________________________________________________________________________
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`I
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`Tltied: SYSTEMS AND METHODS FOR SAMPLE USE iViAXiiv‘iiZATiON
`____________________________________________________________________________________________________________s
`______________________________________________________________________________________________________________________________________________________
`Therancs, inc.
`a Lorporatron
`(Name cl Assignee‘;
`(Type of Assignee, eg , corporation. partnersh:p. university, government agency, etc.)
`
`states that, for the patent appiioation/patent identified above. it is (choose one of options 1. :2. 3 or 4 beiow):
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`1.
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`The assignee of the entire right. title, and interest.
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`2. D An assignee of less than the entire right, titie, and interest (check applicabie pox):
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`i
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`The extent (by percentage) of its ownership interest is >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>‘34'». Additional Statementts) by the owners
`hciding the balance of the interest must he submitted to account hr 109% of the ownership interest.
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`C There are unspecified percentages of ownership. The other parties. inciuding inventors. who together own the entire
`.u
`ri J it, title and interest are:
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`Additionai Statemenns) by the owneris) holding the baiance ot' the interest must he submitted to account for the entire
`right. title. and interest.
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`3. U The assignee of an undivided interest in the entirety (a compiete assignment trom one of the joint inventors was made).
`The other parties. inciuding inventors, who together own the entire right. titie. and interest are:
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` Additional -. “atemeht(s) by the owner(s) hoiding the baiance ot the interes' rntstbesuicrhed to account for the entire
`right. title. and interest.
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`4. D The recipient, via a court proceeding or the iike (so, bankruptcy. probate), of an undivided interest in the entirety is
`ccmpiete transfer of ownership interest was made). The certiiied documeht(s_‘,- showing the transfer is attached.
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`The interest identified
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`option 1, 2 cr 3 above (not option 4) is evidenced by either (choose one ct options A or B beiow):
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`A.
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`[7} An assignment from the inventoris) ot' the patent application/patent identified above. The assignment was recorded in
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`the United States Patent and Trademark Ottice at Reel 0 ”
`or for which a copy
`thereof is attached.
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`B. m A chain of titie from the inventoris), of the patent appiicaticn/patent identified above, to the current assignee as toiicws:
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`rrom:
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`:2 From:
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`To:
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`The document was recorded in the United States Patent and Trademark Office at
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`eei
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`, Frame
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`. or for which a copy thereot is attached.
`To:
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`The document was recorded in the United States Patent and Trademark Office at
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`. or tor which a copy thereof is attached.
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`{Page 1 of 2}
`in is required to obtain
`This coilection or’ information is requ'red by ‘2" CFR 373(k)). The intern
`to tiie (and by the ' ”"iO to
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`ity is governed by 35 1.8.0 “:22 and 37 CFR tit and “H4. T s c
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`JRMS TC) THlS ADDRESS. SEND
`of Commerce. PO. Box 1450, Aiexamna. \I'A 22313»t450. DO NOT SEND FEES OR COMPLE
`Office, tJ.S. Departn‘
`TO: Commissioner tor Patents, RC. Box 1459, Atexandria, VA 22313-145fl.
`
`fyou need. assistance in. compiemg reefer/n, call 1—800—PTO—9199 and select Option 2.
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