`Document Description: Provisional Cover Sheet (SB16)
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`PTOVSB/6 (11-08)
`Approved for use through 01/31/2014 OMB 0654-0032
`U.S, Patent and Trademark Office: U.S, DEPARTMENT OF COMMERCE
`Under the Paperwork Reduction Act of 1995, no persons are required to respond io a collection of information unless it displays a valid OMB control number
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`Provisional Application for Patent Cover Sheet
`This is a request forfiling a PROVISIONAL APPLICATION FOR PATENT under 37 CFR 1.523(c)
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`Inventor(s}
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`a
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`} generated within this form by selecting the Add button.
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`Inventor 1
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`i
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`Given Name
`Middle Name
`Farmily Name
`City
`State
`| Country j
`Ali
`R.
`Rezai
`Columbus
`OH
`| US
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`Family Name
`City
`State
`| Country j
`Nelson
`Columbus
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`inventor 2
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`GivenName
`Randy
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`Middle Name
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`inventor 3
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`Middle Name
`Given Name
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`fn
`Zachary
`Weil
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`Family Name
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`| City
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`Columbus
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`| All Inventors Must Be Listed — Additional Inventor Information blocks may be
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`| Title of Invention
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`APPARATUS, SYSTEMS, AND METHODS FOR TREATING CIRCADIAN
`RHYTHM DISORDERS
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`OSU-020974-US-PRO-1
`Attorney Docket Number (if applicable}
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`Correspondence Address
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`Direct all correspondence to (select one):
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`(e) The address corresponding to Customer Number=|C) Firm or Individual Name
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`t
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`Customer Number
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`The invention was made by an agency of the United States Government or under a contract with an agency of the United
`States Government,
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`(@) No.
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`©) Yes, the nameof the U.S. Government agency and the Government contract numberare:
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`EFS - Web 1.0.4
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`Doc Code: TR.PROV
`Document Description: Provisional Cover Sheet (SB16}
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`PTO/SBITS (14-08)
`Approved for use through 01/34/2074 OMB 0651-0032
`U.S, Patent and Trademark Office: U.S, DEPARTMENT OF COMMERCE
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`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
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`Entity Status
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`Applicant claims smail entity status under 37 CFR 1.27
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`(®) Yes, applicant qualifies for small entity status under 37 CFR 1.27
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`C) No
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`Signature
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`Piease see 37 CFR 1.4(d) for the form of the signature.
`Signature | Date (YYYY-MM-DD)|2042-08-28Richard S. Wesorick/
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`FirstName|pichard S.
`Last Name
`Registration Number
`40871
`Wesorick
`(lf appropriate)
`i
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`EFS - Web 1.0.1
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