PTOIAING1 (06—12)
`Approved for use through 11730l2020. OMB 0651-0032
`0.8. 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 displays a valid OMB control number.
`
`DECLARATION (37 CFR 1.63) FOR UTILITY OR DESIGN APPLICATION USING AN
`APPLiCATION DATA SHEET (37 CFR 1.76)
`
`Title of METHODS AND SYSTEMS FOR IDENTIFYING BRAIN DISORDERS
`Invention
`
`As the below named inventor, I hereby declare that:
`
`This declaration
`.
`.
`is directed to: D The attached appiication, or
`
`IE United States application or PCT international application number
`filed on May 23, 2018
`
`15/987,794
`
`The above-identified application was made or authorized to be made by me.
`
`I believe that i am the original inventor or an original joint inventor of a claimed invention in the application.
`
`I hereby acknowledge that any wiilful 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.
`
`
`
`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,
`petitionerslapplicants 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.
`
`LEGAL NAME OF INVENTOR
`
`Inventor: Padideh KAMALI'ZARE ’
`
`Signature:
`
`Date (Optional) :MAK—
`
`Note: An application data sheet (PTO/88114 or equivalent), including naming the entire inventive entity, must accompany this form or must have
`been previously filed. Use an additional PTO/AINO1 form for each additional inventor.
`
`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 by the 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 1 minute to
`complete, including gathering, preparing, and submitting the completed application term to the USPTO. Time will vary depending upon the individual case. Any
`comments on the amount of time you require to complete this form andlor suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S.
`Patent and Trademark Office, U.S. Departmentof 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.
`ifyou need assistance in completing the form, call 1-800-PTO~9199 and select option 2.
`
`
`
`
`
`

`

`PTOtAIAtO1 (06-12)
`Approved for use through 11l30t2020. 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 displays a valid OMB control number.
`
`DECLARATION (37 CFR 1.63) FOR UTILITY OR DESIGN APPLICATION USING AN
`APPLICATION DATA SHEET (3? CFR 1.76)
`
`Title of METHODS AND SYSTEMS FOR IDENTIFYING BRAIN DISORDERS
`Invention
`
`As the below named inventor, I hereby declare that:
`
`This declaration
`is directed to:
`
`I:
`
`.
`.
`The attached application, or
`
`III United States application or PCT international application number
`May 23, 2018
`filed on
`
`151981794
`
`The above—identified application was made or authorized to be made by me.
`
`I believe that 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.
`
`
`
`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 pubtication 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.
`
`LEGAL NAME OF INVENTOR
`
`,nventor. Kaveh VEJDANI
`
`Signature:
`
`Date (Optional): 552, 4// g
`
`Note: An application data sheet (PTOISBIM or equivalent), including naming the entire inventive entity, must accompany this form or must have
`been previously filed. Use an additional PTOIAINOI form for each additional inventor.
`
`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 by the 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 coitecticn is estimated to take 1 minute 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 andlor suggestions for reducing this burden. should be sent to the Chief Information Officer. U.S.
`Patent and Trademark Office, US. Department of Commerce, P.O. Box1450. Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO
`THIS ADDRESS. SEND TO: Commissioner for Patents, PO. Box 1450. Alexandria, VA 22313-1450.
`If you need assistance in completing the form caii 1-500—PTO-9199 and acted option 2.
`
`
`
`

`

`
`
`a|
`II
`
`|I
`
`PTO/AWN (06-12)
`Approved for use through 11130i2020. OMB 0651-0032
`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 coitection of information unless it displays a valid OMB control number.
`
`DECLARATION (37 CFR 1.63) FOR UTILITY OR DESIGN APPLICATION USING AN
`APPLICATION DATA SHEET (37 CFR 1.76)
`
`Title of METHODS AND SYSTEMS FOR IDENTIFYING BRAIN DISORDERS
`Invention
`
`As the below named inventor, I hereby declare that:
`
`This declaration
`.
`.
`is directed to: D The attached application. or
`D United States application or PCT international application number 15/981794
`tiled on
`May 23, 2018
`
`The above-identified application was made or authorized to be made by me.
`
`I believe that I am the originai 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.
`
`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,
`petitionerslapplicants should consider redacting such personal information from the documents before submitting them to the
`USPTO. Petitionen‘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 it 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.
`
`LEGAL NAME OF INVENTOR
`
`
`
`Thomas LIEBMANN
`
`Inventor:
`
`Signature: ii I 2a
`
`2
`
`Date (Optional) :
`
`Note: An application data sheet (PTOISB/M or equivalent). including naming the entire inventive entity. must accompany this form or must have
`been previously filed. Use an additional PTO/AWN form for each additional inventor.
`
`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 by the 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 1 minute 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 andlor 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.
`
`

`

`PTOIAIAIO1 (06-12)
`Approved for use through 1113012020. OMB 065170032
`U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
`Under the Papenrvork Reduction Act or 1995. no persons are required to respond to a collection of information unless it displays a valid OMB control number.
`
`DECLARATION (37 CFR 1.63) FOR UTILITY OR DESIGN APPLICATION USING AN
`APPLICATION DATA SHEET (37 CFR 1.76)
`'
`
`Titlelof METHODS AND SYSTEMS FOR IDENTIFYING BRAIN DISORDERS
`Invention
`
`As the below named inventor. I hereby declare that:
`
`This declaration
`.
`.
`is directed to: D The attached application. or
`IE United States application or PCT international application number 15/981794
`filed on
`May 23, 2018
`
`I
`
`The above-identified application was made or authorized to be made by me.
`
`I believe that 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.
`
`
`
`WARNING:
`
`-
`
`Petitionerlapplicant 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.
`petitionerslapplicants should consider redacting such personal information from the documents before submitting them to the
`USPTO. Petitioneriapplicant 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.
`
`LEGAL NAME OF INVENTOR
`
`Inventor:
`
`Hesaam ESFANDYARPOUR
`
`Date (Optional) :
`
`Signaturezlg
`
`Note: An application data sheet (PTOISBI14 or equivalent). including naming the entire inventiVe entity. must accompany this form or must have
`been previously filed. Use an additional PTOr‘AIAr'O1 form for each additional inventor.
`
`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 by the public which is to file (and
`by the USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR1.11 and 1.14. This collection is estimated to take 1 minute 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 andlor 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.0. Box 1450, Alexandria. VA 22313-1450.
`Ifyou need assistance in completing the form, calf 1-800—PTO-9 199 and seiecf option 2.
`
`