Fill and Sign the 12 Form Patent Assignment

-1- 5.12 Form: Patent Assignment ASSIGNMENT I, John Smith, residing at ____________, New York, New York, in consideration of $__________ , and other good and sufficient considerations, the receipt of which is hereby acknowledged, by these presents have sold, assigned, transferred and set over, and by these presents sell, assign, transfer and set over unto The Company, Inc., located at , New York, New York, as assignee, and its successors, assigns and legal representatives, effective at least as early as __________, 20__ my entire right, title and interest, for all countries, in and to the invention described in an application for Letters Patent of the United States [Application Serial No. __________] executed on __________, 20__, entitled ____________________, with the inventors ____________________, and all the rights and privileges under any and all Letters Patent that may be granted therefor and thereon and all reissues and extensions thereof; and all applications for industrial property protection, including, without limitation, all applications for patents, utility models, and designs which may hereafter be filed for said invention in any country or countries foreign to the United States, together with the right to file such applications and the right to claim for the same the priority rights derived from said United States application under the Patent Laws of the United States, the International Convention for the Protection of Industrial Property, or any other international agreement or the domestic laws of the country in which any such application is filed, as may -2- be applicable; and all applications for industrial property protection, including, without limitation, all applications for patents, utility models, and designs which may hereafter be filed for said invention in any country or countries foreign to the United States, together with the right to file such applications; and all forms of industrial property protection, including, without limitation, patents, utility models, inventors' certificates and designs which may be granted for said invention in any country or countries foreign to the United States and all extensions, renewals and reissues thereof. I hereby authorize and request the Commissioner of Patents and Trademarks of the United States and any Official of any country or countries foreign to the United States, whose duty is to issue patents or other evidence or forms of industrial property on applications as aforesaid to issue the same to __________, its successors, assigns and legal representatives, or to such nominees as it may designate. I agree that, when requested, I will, without charge to __________ but at its expense, sign all papers, take all rightful oaths, and do all acts which may be necessary, desirable or convenient for securing and maintaining patents for the inventions in any and all countries and for vesting title thereto in __________, its successors, assigns and legal representatives or nominees. I authorize and empower __________, its successors, assigns and legal representatives or nominees, to invoke and claim for any application for patent or other form of -3- protection for the inventions filed by it or them, the benefit of the right of priority provided by the International Convention for the Protection of Industrial Property, as amended, or by any convention which may henceforth be substituted for it, or any other international agreement or the domestic laws of the country in which any such application is filed, as may be applicable, and to invoke and claim such right of priority without further written or oral authorization from me. I hereby consent that a copy of this assignment shall be deemed a full legal and formal equivalent of any assignment, consent to file or like document which may be required in any country for any purpose and more particularly in proof of the right of the assignee or nominee to claim the aforesaid benefit of the right of priority provided by the International Convention for the Protection of Industrial Property, as amended, or by any convention which may henceforth be substituted for it. I covenant with __________, its successors, assigns and legal representatives or nominees that the rights and property herein conveyed are free and clear of any encumbrance, and that I have full right to convey the same as herein expressed. This assignment has been executed by the undersigned on the date opposite my name. Date:_____________, 20__ STATE OF_________________ ) ) SS: COUNTY OF________________ ) -4- This __________ day of __________, ________, 20__ before me personally appeared ____________________, by me personally known, who acknowledged the foregoing instrument by him or her subscribed to be his or her free act and deed. _______________________ Notary Public ฀