Doc Code: TR.PROV
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`Document Description: Provisional Cover Sheet (SE16)
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`PTOVSB/15 (02-18)
`Approved for use through 11/80/2020. OMB 0651-0032
`US, Patent and Trademark Office: U.S. DEPARTMENT OF COMMERCE
`Under the Paperwork Reduction Act of 1995, no persons are required ic respond io 3 collection of information unless it displays a valid OMB control numberPr
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`Provisional Application for Patent Cover Sheet
`This is a request for filing a PROVISIONAL APPLICATION FOR PATENT under 37 CFR 1.53(c)
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`inventor 1
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`State
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`| Middle Name
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`| Joseph Anthony
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`| inventor(s}
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`oeeeeeennennnnnnnnnnnnnnnnnnnnn4
`i Country j
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`| Given Name
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`Maurice
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`inventor 2
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`Given Name
`Middle Name
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` i Dennis
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`inventor 3
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`| Given Name
`| Middle Name
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`| Damien
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`Patrick
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`All inventors Must Be Listed — Additional Inventor Information blocks may be
`| generated within this form by selecting the Add button.
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`i
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`| Title of Invention
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`PEDIATRIC SUSPENSION FORMULATION
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`Attorney Docket Number (if applicable}
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`| Correspondence Address
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`4384 .0010002/MSB/THN
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`| Direct all correspondence to (select one):
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`| C) Firm or individual Name
`(@) The address corresponding io Customer Number
`finnnnn‘
`| Customer Number
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`The invenlion was made by an agency ofthe United States Government or under a contract with an agencyof the United
`i States Government.
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`No.
`eaeeee|
`© Yes, the invention was made by an agency of the Uniied States Governmeni. The U.S. Government agency nameis:
`| O Yes, the invention was under a contract with an agency of the United States Government. The name of the U.S.
`tt
`eeeee!+
`Government agency and Government contraci numberare:
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`EFS - Web 1.0.2
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`Doc Code: TR.PROV
`
`Document Description: Provisional Cover Sheet (SE16)
`
`PTOVSB/15 (02-18)
`Approved for use through 11/80/2020. OMB 0651-0032
`US, Patent and Trademark Office: U.S. DEPARTMENT OF COMMERCE
`Under the Paperwork Reduction Act of 1995, no persons are required ic respond io 3 collection of information unless it displays a valid OMB control number
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`Entity Status
`| Applicant asserts smail entity status under 37 CFR 1.27 or applicant certifies micro entity status under 37 CFR 1.29
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`O Applicant asseris small entity status under 37 CFR 1.27
`C) Applicant certifies micro entity status under 37 CFR 1.29. Applicant must attach form PTO/SB/15A or B or equivalent.
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`| @) No
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`| Warning
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`Petilioner/applicant is cautioned io avoid submitiing personal information in documents filed in a patent application that may |
`| contribule to identity thefl. Personal information such as social securily 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 io support a petition or an application.
`{f this type of personal information is inclucled in documents submitted|
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`io the USPTO, patitioners/applicanis should consider redacting such personal information from the documents before
`| submitting them to USPTO. Petitioner/applicant is advised that the record of a patent application ts available to the public
`| after publication of the application (unless a non-publication request in compliance with 37 CFR 71.213(4) is made in the
`| application} or issuance of a patent. Furihermore, the record from an abandoned application may also be available to the
`| public ifthe application is referenced in a published application or an issued patent (see 37 CFR1.14}. Checks and credit
`| card authorization forms PTO-2038 submitied for payment purposes are not retained in the application file and therefore are |
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`| not publicly available. |a
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`| Signature
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`| Please see 37 CFR 1.4(d) for the form of the signature.
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`/Matthew S. Bodensiein/
`| Date (YYYY-MM-DD)
`| Signature
`2020-08-07
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`First Name
`Last Name
`Registration Number
`Matihew S.
`| Bodenstein
`58885
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`(if appropriate)
`| This collection of information is required by 37 CFR 1.51. The information is required to obtain or retain a benefit by the public which is to
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`file {and by the USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 4.11 and 1.14. This collectio
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`is estimated to take 3 hours to complete, including gathering, preparing, and submitting the completed application form to ihe USPTO.
`| Time will vary depending upon the individual case. Any comments on ihe amount of time you require to complete this formand/or
`| suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S. Patent and Trademark Office, U.S. Departmen
`| of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. This
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`form can only be used when in conjunction with EFS-Web. if this form is mailed te the USPTO, i may cause delays in handling
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`the provisional application.
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`EFS - Web 1.0.2
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`Privacy Act Statement
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`The Privacy Act of 1974 (P.L. $3-879} requires that you be given certain information in connection with your submission of
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`The information provided by you in this form wil be subject to the following routine uses:
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`1.
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`oN
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`The information on this form will be treated confidentially to the exieni allowed under the Freedomof Information
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