Doc Code: TR.PROV
`Document Description: Provisional Cover Sheet (SB16)
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`Provisional Application for Patent Cover Sheet
`This is a requestforfiling a PROVISIONAL APPLICATION FOR PATENTunder 37 CFR 1.53(c)
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`Inventor(s)
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`Inventor 1
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`Country j
`State
`City
`Family Name
`Middle Name
`Given Name
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`feeeeee
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`Inventor 2
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`Given Name
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`Middle Name
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`Family Name
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`City
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`State
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`Country j
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`PTO/SB/16 (02-18)
`Approved for use through 11/30/2020. 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 respondto a collection of information unless it displays a valid OMB control number
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`Customer Number
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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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`Title of Invention
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`Attorney Docket Number (if applicable)
`53341-107PR
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`Correspondence Address
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`Direct all correspondenceto (select one):
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`@) The address corresponding to Customer Number © Firm orIndividual Name
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`The invention was made by an agencyof the United States Governmentor under a contract with an agency of the United
`States Government.
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`Government agency and Government contract number are:
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`Yes, the invention was made by an agencyof the United States Government. The U.S. Government agency name is:
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`Yes, the invention was under a contract with an agency of the United States Government. The nameof the U.S.
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`EFS - Web 1.0.2
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`

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`Doc Code: TR.PROV
`Document Description: Provisional Cover Sheet (SB16)
`
`PTO/SB/16 (02-18)
`Approved for use through 11/30/2020. 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 respondto a collection of information unless it displays a valid OMB control number
`
`Entity Status
`Applicant asserts small entity status under 37 CFR 1.27 or applicant certifies micro entity status under 37 CFR 1.29
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`@) Applicant asserts small entity status under 37 CFR 1.27
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`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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`Warning
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`Petitioner/applicant is cautioned to avoid submitting personal information in documentsfiled in a patent application that may
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`card authorization forms PTO-2038 submitted for payment purposes are not retained in the application file and therefore are
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`
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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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`Signature fo20o-042e|04-28Richard B. Emmons/ Date (YYYY-MM-DD)
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`First Name ferera|B. Registration Number fee|(If appropriate}Last Name
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`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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`form can only be used when in conjunction with EFS-Web. If this form is mailed to the USPTO, it may cause delays in handling
`the provisional application.
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`EFS - Web 1.0.2
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