FOR GOOD AND VALUABLE CONSIDERATION, I/we, the JOINT INVENTOR(S) and ASSIGNOR(S): ____________,
residing at:_________________
HEREBY ASSIGN(s) to the ASSIGNEE: _____________, a _________ corporation existing under the laws of the State
of _______________, with a business mailing address at
ALL RIGHT, TITLE, AND INTEREST WORLDWIDE in and to the invention described in the above-identified US
(provisional/nonprovisional) application entitled _______________, [claiming priority to
, filed ]; and in and to said US patent application and all applications that may be filed
on said invention anywhere in the world, including any and all divisions, reissues, continuations, and extensions
thereof and in and to any Letters Patents, Inventors’ Certificates, Design Registrations, Industrial Models, Utility
Models, and all other forms of protection that may be granted thereon, including the right to file applications and
the right to claim priority from the US application worldwide, and including the right to pursue and obtain any
damages, recoveries, or remedies for past infringements of these protections.
ASSIGNOR(S) covenant(s) that no assignment, license, or encumbrance has been or will be made that would
conflict with this Assignment.
ASSIGNOR(S) request(s) that all Letters Patents, Inventors’ Certificates, Design Registrations, Industrial Models,
Utility Models and all other forms of protection on said invention be issued to the ASSIGNEE, and ASSIGNOR(S)
agree(s) to cooperate fully in obtaining and enforcing patent protection for said invention, including
communicating any facts relating to said invention, signing lawful papers, and, at the request and expense of the
ASSIGNEE, but without compensation, testifying in legal proceedings.
INVENTOR(S EACH) HEREBY DECLARE(S):
The Declaration is directed to the above-identified application _____________________________.
The referenced application was made or authorized to be made by me.
I believe I am (an original inventor) (an original joint inventor) of a claimed invention in the application.
I hereby acknowledge that any willful false statement made in this declaration is punishable under 18 U.S.C. 1001
by fine or imprisonment of not more than five (5) years, or both.
My mailing address is the same as my residence and is listed above below my name.
STATE OF ________ )
C
OUNTY OF ________ )
SS
On the _____ day of ___________________ in the year 2020, before me, the undersigned, a Notary Public in and
for said State, personally appeared (INVENTOR NAME), personally known to me or proved to me on the basis of
satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to
me that he/she/they executed the same in his/her/their capacity, and that by his/her/their signature on the
instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument.
Seal