PTO/AIA/08(11-15)
`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]
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`
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`
`

`

`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
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`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
`
`

`

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`
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