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Patent It Yourself - PDF Archive

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296 | PATENT IT YOURSELF<br />

In the United States <strong>Patent</strong> and Trademark Office<br />

Appn. Number: 11/123,456<br />

Filing Date: 2011 Dec 3<br />

Applicant(s): Goldberger, David<br />

Examiner: Hayness / GAU 654<br />

Mailed: 2011 Dec 3<br />

At: San Francisco<br />

Declaration in Support of Accompanying Petition to Make Special<br />

Reason I—Applicant’s Health Is Poor<br />

In support of the accompanying Petition to Make Special, applicant declares as follows: *<br />

1. I am the applicant in the above-identified patent application.<br />

2. On Aug 15, 2010 I had a massive heart attack and was hospitalized in St. Francis Hospital in San<br />

Francisco for 6 days.<br />

3. My cardiologist, Dr. Weakened Ticker of 909 Hyde St., Suite 2702, San Francisco, advised me during<br />

an office visit on Sep 26, 2010 that I had continuing heart failure and angina and would likely live only<br />

about a year from now. Attached is a certificate from Dr. Ticker to this effect.<br />

4 . By reason of my terminal health condition, I respectfully request that this application be made<br />

special so that I may be able to enjoy the benefit of a patent on my invention while I am alive.<br />

5. I further declare that all statements made herein of my own knowledge are true and that<br />

all statements made upon information and belief are believed to be true, and further that these<br />

statements were made with the knowledge that willful false statements and the like so made are<br />

punishable by fine or imprisonment, or both, under Section 1001 of Title 18 of the United States Code,<br />

and that such willful false statements may jeopardize the validity of the application and any patent<br />

issuing therefrom.<br />

1919 Chestnut Street<br />

Philadelphia, PA 19103<br />

215-237-6639<br />

Very respectfully,<br />

David Goldberger<br />

David Goldberger<br />

Applicant<br />

Fig. 10T—Completed Declaration to Accompany PTMS<br />

*This (and all other papers sent to the PTO) should always be typed with 1.5 or double spacing.

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