Patent
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International

 

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RECORD OF INVENTION

BE IT KNOWN THAT __________________________________________________________
Residing at _________________________________________________________________
City_____________________________ State_________ Zip _________
Phone_____________________ Business Phone ____________________

has conceived the invention illustrated and described within this RECORD OF INVENTION 
document which is called________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
and has this___________ day of _________________________________20_____
disclosed to us this invention and we understand its construction and use.
Witness______________________________ Witness______________________________
                                (Optional)                                                                                         (Optional)

Date of original conception of idea_______________________________________________
Date first disclosed idea to others________________________________________________
Date sketches were first made__________________________________________________
Working Model (  ) has (  ) has not (check one) been made.
Has a patent search been made? ___________ When?_______________________________
What did search reveal in relation to existing patents? _________________________________
__________________________________________________________________________
Are any particular molds or tools needed to make your inventions?________________________
State of

________________

 

County of

 

________________

 

 I, __________________________________________________________
(Type or Print Your Name)

_______being duly sworn, upon oath depose and state that I believe myself to
be the original, first and sole inventor of the device described herein,
and that all dates and statements made herein are true to the best of my
knowledge and belief.

__________________________________________________________
(Your Signature)

Sworn and subscribed before me
this_____________________________ day of_______________ 20-___

Notary Public ______________________________________________________
_________________________________________________________________
                                                                     (Optional)