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`fist Pilii’ti'iai” Name: m '
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`5:: Giobai ii"
`Esme: QPCT! UFariS.
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`Page: 1 M 2
`”is: Patina! Ref {if needad}:
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`‘ Pi—iC~USiODQEi-;A
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`fiCA! BOW! DEEP! 88330353
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`PTCII'AIRJ'D‘: (06": 2)
`Approved {Dr use through 0 173112014.
`0MB 0651’0032
`U. 3 Patent and deamark Office; Li. S. DERARTMENT OF COMMERCE
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`Limits: if"; Paperwcrk Reducfibn Ami m' 1995. no persmis are required to respund 10 s ao’iiaction Bf information uni-3:45 it dispiays a vaiid OMB control Rumbas
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`SECLJQRATEQN {3? CFR 163} HER Mimi“? QR {imiam figPPLiEfis'fiQN Mamas AN
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`AP?L§CAT§§§N 31% SHEET i3? QECR ‘ifffié
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`mag-s {33°
`Emmi-aims:
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`As the beiuw named invenian i hereby deciare that:
`
`“his fiefiiamiieri
`is directed to:
`
`:
`
`'
`
`The attached appiisaiicm, m
`
`,
`[3 United States applicaiian or PCT iniemationai appiicaiion number
`
`
`
`flied cm
`
`The abovenidestified application was maria m authorized m be made by me
`
`
`wave that i am the (ii‘igiiizii invenim or an (s nai joint inventor 0?: a claimed irwentim'i in {he aspiication.
`
`i hereby acknowiedge that any wiiifui faise statement made in this deciaratim i=3 punisiiabie under '38 US‘C.‘ 1001
`’ by fine at imprismnmen’: pf moi mare. than five {5) years, at bath.
`
`WARNENG:
`
`3 Petitionen’apgiimnt is cautioned I“) amid submitting personal informatian in (Secumenis flied in a patent appiicatian that may
`c-zyriiribute is idsntiiy theft. Persenai infarmaatian :such as soda: security numbersi bani: account fiUl’i’ibei’S, as credit cai‘cfi numbers
`(other than a check or credit card authmization farm PTG—ZOBS submitted for payment purpeses} is rim/er required by the USF‘TO
`tn summit a petition Dr an appiicatiaam if this typa mi perscnai infarmaeiion is inciuded in demmenfi submitted in the USPTU,
`peiiiimiarslappiicanis shamici consider redactirig such personai initirrnaiion {mm the documents befare submitting them it: the
`_ USPTQ. Fetitionarfapgiicani: is advised that the} recard of a paient appiicaiion is avaiiabie to the pubiic after pubiicatien 0f the
`i appiicaiim (uniess a negre—gaubiication request in (:crripiiance with 37" QFR 1.213(3) is made. in the appiiceaiion} m issuance: 01‘ a
`. paterzi. Furthermore. the record {ram an ahandaned appiigatisn may airso be available ie the pubiic ii" the. appiica‘iion is
`5 raferaricieci in a pubiisi‘ied appiicaiinn or an issued patent (see 3? {FR 1214). Checks and credit card auiiiarizfiiim forms
`P302338 submitted for payment purpoaes are nut .etainéd in the appiicaiim file and {heremre are rim pubiiciy avaiiab‘ie.
`
`LEGAT NAME OF iNV‘ENTGR
`
`inventor:
`
`Hiram mi EEAKi
`
`Note: An agipiication o‘ata shes-i {F‘TOJSBIM or equivaieemi, imam-ding naming the Sfliii‘e inventive smiity, must atmmpany ihis farm.
`Use an addiiinnai PTOJAiA/Q’i form {or each additional invents):
`
`
`
`This coiiaciion of infarmssiion is required by 35 U593 i 15 and 3? CFR 1.68.7 The. informaiion i9 immirad {ti tit-1am or retain a benefit by the pubiic which is to Hie {and
`by the USPTO to primes ) 5m appiirsation. Confidemia y is guvmnefi by 35 LLSL‘. 1.22 and 37 CFR 1.
`anti 'L'HL This miieciion is asiimaied is take 1 minute 10
`
`Gi‘ii’iWE-‘ie: inciuding game-Ping: preparing. and submittim ihé mmpieted appiicaiian form to the USPTO. {Ema wiii vary depending upon the individuai 3339. Any
`
`ibis iris-m andibr suggestions fur ramming {his human, .s-muid be sent to the Chief informaiion Office-2n LIES.
`Gami‘imnis 0n the amount cf ii-me you require it; sample
`Pawn! arid Trademark Office, £3.23. Deparimem 01' Cum;
`:52, RD. Em: 1:25:21, Alexandria, VA 223134456). DO N'GT‘SEND FEES 0R CBMPLETED FORMS TO
`‘n—iis ADDRESS 5ENE3 ”f0: aommissicnfir So: Patents, PX}. Bag 145%, Aiexandria, VA 22313445G‘.
`ifyou need assi'sfsnm‘: in mmpiering the farm, .73}; 1.590.;3TQ4J199 am“ 59539; {um-0,, ;
`
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