Fill and Sign the Assignment Interest Patent Form

ASSIGNMENT OF INTEREST IN UNITED STATES PATENT Assignor,____________________________, hereby sells, transfers, conveys and assigns to Assignee,____________________________, for good and valuable consideration, all of Assignor’s right, title and interest to in the following patent(s): Patent/Application No. Date Application Filed Inventor Invention Title Assignor owns all interest in the above described patent(s) unless otherwise stated herein. The effective date of this assignment is the _____day of ________________, 20____. Executed and agreed to this the _____day of _________________, 20___. ________________________ ________________________ Assignor Assignee by: by: ________________________ ________________________ Name and Title Name and Title Address of Assignor: Address of Assignee: STATE OF _____________ COUNTY OF __________ - 1 - Personally appeared before me, the undersigned authority in and for the said county and state, on this ____day of 20____, within my jurisdiction, the within named____________________who acknowledged that he/she is ______________of _____________________, a corporation, and that on behalf of the said corporation, and as its act and deed he/she executed the above and foregoing instrument, after first having been duly authorized by said corporation so to do. ___________________ (NOTARY PUBLIC) My Commission expires: ___________________ STATE OF ____________ COUNTY OF __________ Personally appeared before me, the undersigned authority in and for the said county and state, on this____day of 20____, within my jurisdiction, the within named____________________who acknowledged that he/she is______________if_______________________, a corporation, and that on behalf of the said corporation, and as its act and deed he/she executed the above and foregoing instrument, after first having been duly authorized by said corporation so to do. ___________________ (NOTARY PUBLIC) My Commission expires: ___________________ - 2 -