`Doc Code: Oath
`Approved for use through 4/30/2017. OMB 0651—0032
`Document Description: Oath or declaration filed
`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 contains a valid OMB control number.
`
`Att°meyD°°ket
`Number
`.
`.
`First Named Inventor Elizabeth Rose Dyor
`COMPLETE IF KNOWN
`Application Number
`15/398,003
`_
`_
`Filing Date
`.
`A” Un't
`Examiner Name
`
`2126.10
`
`01/04/2017
`
`2876
`
`DECLARATION FOR UTILITY OR
`
`DESIGN
`PATENT APPLICATION
`(37 CFR 1_63)
`
`Declaration
`Submitted
`With Initial
`Filing
`
`OR
`
`Declaration
`Submitted After Initial
`Filing (surcharge
`(37 CFR1.16(f))
`re uired
`q
`)
`
`Financial Management System
`
`
`
`Telephone
`
`As a below named inventor, I hereby declare that:
`
`This declaration is directed to:
`
`(Title of the Invention)
`
`[:1 The attached application,
`OR
`
`United States Application Number or PCT International application number 15/398903
`
`filed on JUne 04, 2017
`
`The above-identified application was made or authorized to be made by me.
`
`I believe I am the original inventor or an original joint inventor of a claimed invention in the application.
`
`I hereby acknowledge that any willful false statement made in this declaration is punishable under 18 U.S.C. 1001
`by fine or imprisonment of not more than five (5) years, or both.
`
`Direct all
`correspondence to:
`
`The address
`
`assomated W'th
`Customer Number:
`
`69656
`
`Correspondence
`on m address below
`
`[Page 1 of 2]
`This collection of information is required by 35 U.S.C. 115 and 37 CFR 1.63. The information is required to obtain or retain a benefit bythe public which is to file (and by
`the USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 21 minutes to
`complete. including gathering. preparing. and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any
`comments on the amount of time you require to complete this form and/or suggestions for reducing this burden. should be sent to the Chief Information Officer. U.S.
`Patent and Trademark Office. U.S. Department of Commerce, PO. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS
`ADDRESS. SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
`
`If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.
`
`
`
`PTO/AlA/08 (1 1-15)
`Approved for use through 4/30/2017. OMB 0651-0032
`US. Patent and Trademark Office; US. DEPARTMENT OF COMMERCE
`Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number.
`
`DECLARATION — Utility or Design Patent Application
`
`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 the
`USPTO. Petitioner/applicant is advised that the record of a patent application is available to the public after publication of the
`application (unless a non-publication request in compliance with 37 CFR 1.213(a) is made in the application) or issuance of a
`patent. Furthermore, the record from an abandoned application may also be available to the public if the application is referenced
`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.
`Petitioner/applicant is advised that documents which form the record of a patent application (such as the PTO/SB/01) are placed
`into the Privacy Act system of records DEPARTMENT OF COMMERCE, COMMERCE-PAT-7, System name: Patent Application
`Files. Documents not retained in an application file (such as the PTO-2038) are placed into the Privacy Act system of
`COMMERCE/PAT-TM-1 0, System name: DepositAccounts and Electronic Funds Transfer Profiles.
`
`LEGAL NAME OF SOLE OR FIRST INVENTOR:
`
`(E.g., Given Name (first and middle if any) and Family Name or Surname)
`
`Supplemental sheet(s)PTO/AlA/1O attached hereto
`
`Elizabeth Rose Dyor
`
`Inventor's Signature
`
`/E|izabeth Rose Dyor/
`
`Residence: City
`Bellevue
`
`Var mg ‘ uress
`1646 184th Ave. NE
`
`City
`Bellevue
`
`Date (Optional)
`
`Country
`US
`
`98008
`
`State
`
`Country
`
`E Additional inventors are being named on the
`
`
`
`Privacy Act Statement
`
`The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with
`your submission of the attached form related to a patent application or patent. Accordingly, pursuant to
`the requirements of the Act, please be advised that: (1) the general authority for the collection of this
`information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary; and (3) the
`principal purpose for which the information is used by the US. Patent and Trademark Office is to process
`and/or examine your submission related to a patent application or patent. If you do not furnish the
`requested information, the US. Patent and Trademark Office may not be able to process and/or examine
`your submission, which may result in termination of proceedings or abandonment of the application or
`expiration of the patent.
`
`The information provided by you in this form will be subject to the following routine uses:
`
`1 . The information on this form will be treated confidentially to the extent allowed under the
`Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records
`from this system of records may be disclosed to the Department of Justice to determine
`whether disclosure of these records is required by the Freedom of Information Act.
`A record from this system of records may be disclosed, as a routine use, in the course of
`presenting evidence to a court, magistrate, or administrative tribunal, including disclosures
`to opposing counsel in the course of settlement negotiations.
`A record in this system of records may be disclosed, as a routine use, to a Member of
`Congress submitting a request involving an individual, to whom the record pertains, when
`the individual has requested assistance from the Member with respect to the subject matter
`of the record.
`
`A record in this system of records may be disclosed, as a routine use, to a contractor of the
`Agency having need for the information in order to perform a contract. Recipients of
`information shall be required to comply with the requirements of the Privacy Act of 1974, as
`amended, pursuant to 5 U.S.C. 552a(m).
`A record related to an International Application filed under the Patent Cooperation Treaty in
`this system of records may be disclosed, as a routine use, to the International Bureau of the
`World Intellectual Property Organization, pursuant to the Patent Cooperation Treaty.
`A record in this system of records may be disclosed, as a routine use, to another federal
`agency for purposes of National Security review (35 U.S.C. 181) and for review pursuant to
`the Atomic Energy Act (42 U.S.C. 218(0)).
`A record from this system of records may be disclosed, as a routine use, to the
`Administrator, General Services, or his/her designee, during an inspection of records
`conducted by GSA as part of that agency's responsibility to recommend improvements in
`records management practices and programs, under authority of 44 U.S.C. 2904 and 2906.
`Such disclosure shall be made in accordance with the GSA regulations governing inspection
`of records for this purpose, and any other relevant (i.e., GSA or Commerce)
`directive. Such disclosure shall not be used to make determinations about individuals.
`
`A record from this system of records may be disclosed, as a routine use, to the public after
`either publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent
`pursuant to 35 U.S.C. 151. Further, a record may be disclosed, subject to the limitations of
`37 CFR 1.14, as a routine use, to the public if the record was filed in an application which
`became abandoned or in which the proceedings were terminated and which application is
`referenced by either a published application, an application open to public inspection or an
`issued patent.
`A record from this system of records may be disclosed, as a routine use, to a Federal,
`State, or local law enforcement agency, if the USPTO becomes aware of a violation or
`potential violation of law or regulation.
`
`

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