Application Data Sheet 37 CFR 1.76
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`Title of Invention
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`Attorney Docket Number
`.
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`Application Number
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`41270030008
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`15/689,905
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`PTO AIA/14 Euivalent (11-15)
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`FLUIDIC MEDIAL DEVICES AND USES THEREOF
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`The application data sheet is part of the provisional or nonprovisional application for which it is being submitted. The following form contains the bibliographic
`data arranged in a format specified by the United States Patent and Trademark Office as outlined in 37 CFR 1.76.
`This document may be completed electronically and submitted to the Office in electronic format using the Electronic Filing System (EFS) or the document may be
`printed and included in a paper filed application.
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`A I Ilicant In 0rmati0n:
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`Providing assignment information in this section does not substitute for compliance with any requirement of part 3 of Title 37 of the CFR to
`have an assignment recorded by the Office.
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`Applicant 1
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`If the applicant is the inventor (or the remaining joint inventor or inventors under 37 CFR 1.45), this section should not be completed. The
`information to be provided in this section is the name and address of the legal representative who is the applicant under 37 CFR 1.43; or the
`name and address of the assignee, person to whom the inventor is under an obligation to assign the invention, or person who otherwise shows
`sufficient proprietary interest in the matter who is the applicant under 37 CFR 1.46. If the applicant is an applicant under 37 CFR 1.46
`(assignee, person to whom the inventor is obligated to assign, or person who otherwise shows sufficient proprietary interest) together with one
`or more joint inventors, then the joint inventor or inventors who are also the applicant should be identified in this section.
`
`El Legal Representative under 35 U.S.C. 117
`IXI Assignee
`[I Person to whom the inventor is obligated to assign
`[I Person who shows sufficient proprietary interest
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`If Applicant is the legal representative, indicate the authority to file the patent application, the inventor is:
`[I Deceased
`El Legally Incapacitated
`Name ofthe Deceased or Legally Incapacitated Inventor: —
`If the Applicant is an Organization check here: XI
`Oranization Name:
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`
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`Postal Code
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`9456019801
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`Address 1
`Address 2
`Cnt
`Countr
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`Si . nature:
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`NOTE: This Application Data Sheet must be signed in accordance with 37 CFR 1.33(b). However, if this Application Data Sheet is
`submitted with the INITIAL filing of the application M either box A or B is n_0t checked in subsection 2 of the “Authorization or Opt-
`Out of Authorization to Permit Access” section, then this form must also be signed in accordance with 37 CFR 1.14(c).
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`This Application Data Sheet M be signed by a patent practitioner if one or more of the applicants is a juristic entity (e.g., corporation or
`association). If the applicant is two or more joint inventors, this form must be signed by a patent practitioner, a_ll joint inventors who are the
`applicant, or one or more joint inventor-applicants who have been given power of attorney (e.g., see USPTO Form PTO/AIA/81) on behalf of
`a_ll joint inventor-applicants.
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`See 37 CFR 1.4(d) for the manner of making signatures and certifications.
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`
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`Signature
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`/Richard D. Coller 111/
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`Date (YYYY-MM-DD)
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`2020-04-17
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`Richard D.
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`Coller 111
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`Registration Number
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`60,390
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`1482376871
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`