Date: _________________

Box DD Assistant Commissioner for Patents Washington, District of Columbia 20231 Request for Participation in Disclosure Program:
Disclosure of: _____________________________________________
Your Name(s)
Entitled: _________________________________________________
Title of Disclosure
Sir: Attached is a copy of a disclosure of my above-entitled invention (consisting of ______ sheets of written description and ______separate drawings or photos), a $__________ check and a stamped receipt postcard. The undersigned respectfully requests that this disclosure be accepted and retained for two years (or longer if it is later referred to in a paper filed in a patent application) under the Disclosure Document Program and that the enclosed postcard be date stamped, numbered and returned. The undersigned understands that (1) this disclosure document is neither a patent application or a substitute for one, (2) its receipt date will not become the effective filing date of a later-filed patent application, (3) it will be retained for two years and then destroyed unless it is referred to in a patent application, (4) this two-year retention period is not a "grace period" during which a patent application can be filed without loss of benefits, (5) in addition to this document, proof of diligence in building and testing the invention, and/or filing a patent application on the invention, may be vital in case of an interference, and in other situations, (6) if such building and testing is done, signed, and dated, records of such should additionally be made and these should be witnessed and dated by disinterested individuals (not the PTO), and (7) if any public use or sale of the invention is made in the U.S., or any publication is made anywhere, no valid patent can be granted on the invention unless a patent application is filed on it within one year of any such public use, sale or publication, regardless of the filing date of this Disclosure Document.
Very respectfully,
_____________________________ Signature of Inventor	_____________________________ Signature of Joint Inventor
_____________________________ c/o (Print Name)	_____________________________ Print Name
_____________________________ Address	_____________________________ Address
_____________________________	_____________________________
Enclosures: As stated above

 

Invention Disclosure

Sheet ____ of ____

Inventor(s): ______________________________________________

Address(es): _____________________________________________

cheap hotels in Newcastle Title of Invention: ________________________________________

To record Conception, describe: 1. Circumstances of conception, 2. Purposes and advantages of invention, 3. Description, 4. Sketches, 5. Ramifications, 6. Possible novel features, and 7. Closest known prior art. To record Building and Testing, describe: 1. Any previous disclosure of conception, 2. Construction, 3. Ramifications, 4. Tests, and 5. Test results. Include sketches and photos, where possible. Continue on additional identical copies of this sheet if necessary; inventors and witnesses should sign all sheets.

Inventor(s): ____________________________ _____________________________________	Date _____/_____/_____ Date _____/_____/_____
The above confidential information is Witnessed and Understood:
_____________________________________ _____________________________________	Date _____/_____/_____ Date _____/_____/_____

 

CONTACT FOR INFORMATION: Mark Manley, Consulting Engineer; Bill McKnight, Consulting Engineer - Center For Technology And Small Business Development (660) 543-4402 or 543-8162 (Call to request a hard copy of the forms above) Central Missouri State University Small Business Development Center Center for Technology and Small Business, G-009 Warrensburg, MO 64093 Phone (660) 543-4402 or (660) 543-8162 FAX (660) 543-8159