Fill and Sign the Invention Disclosure Formdocx South Dakota State University

- 1 - ASSIGNMENT OF INTEREST IN UNITED STATES PATENT Assignor,____________________________, hereby sells, transfers, conveys and assigns toAssignee,____________________________, for good and valuable consideration, all of Assignor’s right, title and interest to in the following patent(s):Patent/Application No. Date Application FiledInventorInvention TitleAssignor 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 Assigneeby:by:________________________ ________________________ Name and Title Name and TitleAddress of Assignor: Address of Assignee:STATE OF _____________ - 2 - 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 ______________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:___________________