PTO/SB/25 (0-) Approved for use through 07/31/201. OMB 0651-00 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 collection of information unless it displays a valid OMB control number. TERMINAL DISCLAIMER TO OBVIATE A PROVISIONAL DOUBLE PATENTING REJECTION OVER A PENDING “REFERENCE” APPLICATION Docket Number (Optional) In re Application of: Application No.: Filed: For: The owner*, , of percent interest in the instant application hereby disclaims, except as provided below, the terminal part of the statutory term of any patent granted on the instant application which would extend beyond the expiration date of the full statutory term of any patent granted on pending reference Application Number , filed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³DV WKH WHUP RI DQ\ SDWHQW JUDQWHG RQ VDLG UHIHUHQFH DSSOLFDWLRQ PD\ EH VKRUWHQHG E\ DQ\ WHUPLQDO GLVFODLPHU ILOHG SULRU WR WKH JUDQW RI DQ\ SDWHQW RQ WKH SHQGLQJ UHIHUHQFH DSSOLFDWLRQ´ LQ WKH HYHQW WKDW DQ\ VXFK SDWHQW JUDQWHG RQ WKH SHQGLQJ UHIHUHQFH DSSOLFDWLRQ H[SLUHV IRU IDLOXUH WR SD\ D PDLQWHQDQFH IHH LV KHOG XQHQIRUFHDEOH LV IRXQG LQYDOLG E\ D FRXUW RI FRPSHWHQW MXULVGLFWLRQ LV VWDWXWRULO\ GLVFODLPHG LQ ZKROH RU WHUPLQDOO\ GLVFODLPHG XQGHU  &)5  KDV DOO FODLPV FDQFHOHG E\ D UHH[DPLQDWLRQ FHUWLILFDWH LV UHLVVXHG RU LV LQ DQ\ PDQQHU WHUPLQDWHG SULRU WR WKH H[SLUDWLRQ RI LWV IXOO VWDWXWRU\ WHUP DV VKRUWHQHG E\ DQ\ WHUPLQDO GLVFODLPHU ILOHG SULRU WR LWV JUDQW Check either box 1 or 2 below, if appropriate. 1. For submissions on behalf of a business/organization (e.g., corporation, partnership, university, government agency, etc.), the undersigned is empowered to act on behalf of the business/organization. I hereby declare that all statements made herein of my own knowledge are true and that all statements made on information and belief are believed to be true; and further that these statements were made with the knowledge that willful false statements and the like so made are punishable by fine or imprisonment, or both, under Section 1001 of Title 18 of the United States Code and that such willful false statements may jeopardize the validity of the application or any patent issued thereon. 2. The undersigned is an attorney or agent of record. Reg. No. __________________ ________________________________________________________________________ _______________________ Signature Date ________________________________________________________________________________________________ Typed or printed name _________________________________ Telephone Number Terminal disclaimer fee under 37 CFR 1.20(d) is included. WARNING: Information on this form may become public. Credit card information should not be included on this form. Provide credit card information and authorization on PTO-2038. *Statement under 37 CFR 3.73(b) is required if terminal disclaimer is signed by the assignee (owner). Form PTO/SB/96 may be used for making this statement. See MPEP § 324. This collection of information is required by 37 CFR 1.321. 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 12 minutes 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 and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S. Patent and Trademark Office, U.S. Department of Commerce, P.O. 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. American LegalNet, Inc. www.FormsWorkFlow.com Privacy Act Statement The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with your submission of the attached form related to a patent application or patent. Accordingly, pursuant to the requirements of the Act, please be advised that: (1) the general authority for the collection of this information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary; and (3) the principal purpose for which the information is used by the U.S. Patent and Trademark Office is to process and/or examine your submission related to a patent application or patent. If you do not furnish the requested information, the U.S. Patent and Trademark Office may not be able to process and/or examine your submission, which may result in termination of proceedings or abandonment of the application or expiration of the patent. The information provided by you in this form will be subject to the following routine uses: 1. 2. 3. 4. 5. 6. 7. 8. 9. The information on this form will be treated confidentially to the extent allowed under the Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from this system of records may be disclosed to the Department of Justice to determine whether disclosure of these records is required by the Freedom of Information Act. A record from this system of records may be disclosed, as a routine use, in the course of presenting evidence to a court, magistrate, or administrative tribunal, including disclosures to opposing counsel in the course of settlement negotiations. A record in this system of records may be disclosed, as a routine use, to a Member of Congress submitting a request involving an individual, to whom the record pertains, when the individual has requested assistance from the Member with respect to the subject matter of the record. A record in this system of records may be disclosed, as a routine use, to a contractor of the Agency having need for the information in order to perform a contract. Recipients of information shall be required to comply with the requirements of the Privacy Act of 1974, as amended, pursuant to 5 U.S.C. 552a(m). A record related to an International Application filed under the Patent Cooperation Treaty in this system of records may be disclosed, as a routine use, to the International Bureau of the World Intellectual Property Organization, pursuant to the Patent Cooperation Treaty. A record in this system of records may be disclosed, as a routine use, to another federal agency for purposes of National Security review (35 U.S.C. 181) and for review pursuant to the Atomic Energy Act (42 U.S.C. 218(c)). A record from this system of records may be disclosed, as a routine use, to the Administrator, General Services, or his/her designee, during an inspection of records conducted by GSA as part of that agency’s responsibility to recommend improvements in records management practices and programs, under authority of 44 U.S.C. 2904 and 2906. Such disclosure shall be made in accordance with the GSA regulations governing inspection of records for this purpose, and any other relevant (i.e., GSA or Commerce) directive. Such disclosure shall not be used to make determinations about individuals. A record from this system of records may be disclosed, as a routine use, to the public after either publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent pursuant to 35 U.S.C. 151. Further, a record may be disclosed, subject to the limitations of 37 CFR 1.14, as a routine use, to the public if the record was filed in an application which became abandoned or in which the proceedings were terminated and which application is referenced by either a published application, an application open to public inspection or an issued patent. A record from this system of records may be disclosed, as a routine use, to a Federal, State, or local law enforcement agency, if the USPTO becomes aware of a violation or potential violation of law or regulation. American LegalNet, Inc. www.FormsWorkFlow.com