Inventor's Confidential Invention Disclosure Form

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-U. S. PATENT APPLICATION FILING STATUS- PROVISIONAL________ APPROVED:______________ DENIED:________________________________
DATE FILED:______________USPO SER. NO.__________________________
-FOREIGN FILING STATUS- FOREIGN FILING LICENSE GRANTED ON:_____________________________ FOREIGN FILING OF APPLICATION:__________________________________ APPROVED:________________________ DENIED:______________________ U.S. PATENT NO.____________________ ISSUED:______________________ Copyright l996, Legal and Patent Search, Inc., All Rights Reserved Worldwide. PROOF OF INVENTION CHOOSE AND INSERT A TITLE FOR YOUR INVENTION: RECORD OF CONCEPTION OF INVENTION: a. Date of first oral disclosure? To whom?___________________________________ b. Date of first drawing: Where is the first drawing?______________________ c. Date of first written description: Where is the first written description?_________________________________________________ CONSTRUCTION OF INVENTION a. Date completed? ________________ b. By whom made?________________________________________________________ c. Experimental model? Beta testing?________________ TESTS OF INVENTION a. Date? b.Witnesses?_______________ c . Results ?________________ PUBLICATION a. Has a description of invention been published?_____________________________________ b . Dates:_____________________________________________________________________ c . Titles?_____________________________________________________________________ d. Published where ?____________________________________________________________ SALE a. Was invention sold or used in public view?_______________________________________ b. Date of first sale or public use?________________________________________________ ATTACH COPIES OF ALL RELATED PUBLICATIONS, PATENTS, PATENT APPLICATIONS YOU ARE AWARE OF AND A LIST SHOWING EACH. GOVERNMENT RIGHTS Was invention conceived of or made during performance of a U.S. government contract? ____ If so what is the government contract no.? ________________________________ First Inventor's Signature: _____________________ Date:_____________ Second Inventor's Signature: _____________________ Date:_____________ Third Inventor's Signature: _____________________ Date:_____________ Witnessed, Read, and Understood By: ________________ Date:_____________ Printed Name of Witness: _____________________ Phone:_____________ BRIEF DESCRIPTION OF THE INVENTION I. Write a brief summary of your invention here but attach additional pages as necessary. Be sure to describe in detail each of the different essential working parts shown in your sketch. II.What does your invention do better? III. How does your invention work? IV. Are there any other products or methods on the market or known to you which are similar to your invention? If so, name and describe the product or method most closely related to your invention: V. How is your invention an improvement or advantage over this product or method? [If you need more space for this description attach additional sheets as needed.] ROUGH SKETCH OF YOUR INVENTION Attach a sketch which illustrates to the best of your ability the major working parts of your invention: If you already have engineering drawings, illustrations, or photographs, please label and attach copies to this document and briefly describe each. ____________________________________________________________ ______  HELPFUL GUIDELINES FOR COMPLETING YOUR INVENTION DISCLOSURE DOCUMENT In preparing the Disclosure Document, co-inventors should designate a leader to follow these guidelines and supply at least the information indicated in the following outline: A. Fill out the Disclosure Document as completely as possible, indicating not applicable, unknown, to be supplied or unavailable where necessary. B. Make sure to include the following items of information in the Disclosure . Use additional sheets of paper, if necessary. 1) Name of invention. 2) General description of invention and the problem it solves. 3) Prior equipment and/or methods for solving the same problem (give technical references and patents where known). 4) Disadvantages of prior equipment and/or methods. 5) Advantages of present invention, both inherently and over the prior equipment and/or methods used. 6) A brief description of the invention and its operation including sketches,graphs, circuit diagrams, auxiliary equipment, and any peculiar methods of construction. 7) The description should explain the sketches and other materials in simple everyday terms to the extent possible. 8) It is not necessary to type in your responses. 9) You are not required to obtain your supervisor's approval to submit an invention disclosure or provide a copy of this document to him or her. A supervisor is not automatically a co-inventor unless he actually contributed to the conception or reduction of the idea to practice. This document should be sent directly to: Attention of Jeryl Tuckman, Certified Paralegal, Legal and Patent Search, Inc., 1901 North Olden Avenue, Trenton, NJ 08618 and marked PRIVATE AND CONFIDENTIAL - PROPRIETARY SUBJECT MATTER. Should you need assistance please call and ask for our corporate advisors at 1-800-468-3686. A $50 FEE IS CHARGED IN ADVANCE FOR UP TO 1/3 HOUR. PLEASE HAVE YOUR VISA, MASTERCHARGE, OPTIMA OR AMEX CARD AVAILABLE. EXTREMELY IMPORTANT! All inventors must sign and date the Disclosure . All inventors, and at least one witness who has read and understood the disclosure must sign and date the Disclosure and each sheet of paper if additional sheets are attached.