PTO/AIA/53 (09-12)
Approved for use through 01/31/2020. OMB 0651-0033
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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REISSUE APPLICATION: CONSENT OF ASSIGNEE;
STATEMENT OF NON-ASSIGNMENT
This is part of the application for a reissue patent based on the original patent identified below.
Name of Patentee(s)
Patent Number Date Patent Issued
Title of Invention
1. Filed herein is a statement under 37 CFR 3.73(c). (Form PTO/AIA/96)
2.
Ownership of the patent is in the inventor(s), and no assignment of the patent is in effect.
One of boxes 1 or 2 above must be checked. If multiple assignees, complete this form for each assignee. If
box 2 is checked, skip the next entry and go directly to “Name of Assignee.”
The
written
consent
of
all
assignees
and inventors ow
ning an undivided interest
in the
original
patent is included in this application for reissue.
The assignee(s) owning an undivided interest in said original patent is/are _,
and the assignee(s) consents to the accompanying application for reissue.
Name
of
assignee/inventor
(if
not
assigned)
Signature Date
Typed or printed name and title of person signing for assignee (if assigned)
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Privacy Act Statement
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection
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