PTO/VGB/43 (07-09)
`Approved for use through 07/31/2012. OMB 0651-0034
`U.S. Patient and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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`inumber, Under the Paperwork Reduction Aci of 1995, no persons are required to respond to a collection of information unles splays a valid OME o
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`DISCLAIMER IN PATENT UNDER 37 CFR 1.321 {a}
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`Name of Patentee
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`Patent Number
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`Docket Number (Optional
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`i Date Patent Issued
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`i
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`i Tite of Invention
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`: REFRIGERANT WITH LUBRICATING OIL FOR REPLACEMENT OF R22 REFRIGERANT]
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`| hereby disclaimthe following complete claims in the above identified patent: :
`Glaims 1, 2,3, 4,5, 6,7, 8,9, 10, 11, and 12
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`: The extent of my interest in said patent is Gf assignee of record, state liber and page, or reel and frame, where
`| assignment is recorded):
`100% (Reel/Frame 063595 / 0444)
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`: The fee for this disclaimeris set forth in 37 CFR 1.20).
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`Paientee claims small entity siatus. See 37 GFR 1.27.
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`Small entity status has already been established in this case, and is sill proper.
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`A check in the amount of the fee is enclosed.
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`Payment by credif card. Form PTO-2038 is atlached.
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`The Director is hereby authorized to charge any fees which may be required or credit any
`avergayment to Deposit Account No. 604493
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`WARNING: information on this form may become public. Credit card information should not
`be included on this form. Provide credit card information and authorization on PTO-2038.
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`petayatone
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`(and by the
`This collection of information is required by 37 CFR 1.321. The information is required to obtain or retain a benefit by the public which is to file
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`SS
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`USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 4
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`compiete, including gathering. preparing, and submitting the compleied application form io the USPTO. Time will vary depending upon the individual case.
`Any comments on the amount of time you require to complete this form and/or suggestions for reducing this burden, should be sent ta the Chief Information
`Officer, US. Patent and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR
`COMPLETED FORMS TO THIS ADDRESS. SEND TO: Commissioner for Patents, P.O. Box 7490, Alexandria, VA 22343-1450.
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`| Signed at_ Alpharetta _ State of_Georgia this 28th day of June 20.23.
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`{Jason M. Perifla/
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`Signature
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`Jason M. Perilia
`Typed or printecl name of patentee/ aitommey or agent of record
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`65734
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`Registration Number, if
`applicable
`(779) 927-7802
`Telephone Nunvoer
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`44 Milton Avenue, Suite 144
`Address
`Aipharetta, GA 30009
`City, State, Zio Code or Foreign Country as applicable
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`if you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.
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`Privacy Act Stafement
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`The Privacy Act of 1974 (P.L. 93-879} requires thai you be given certain information in connection
`with your submission of the attached form relaied to a patent application or patent. Accordingly,
`pursuant to the requirements of the Act, please be advised that: (1} the general authority for the
`collection of ihis information is 35 U.S.C. 2(p)(2); @) furnishing of the information solicited is voluntary;
`and (3) the principal purpose for which the information is used by the U.S. Patent and Trademark
`Office is to process and/or examine your submission related to a patent application or patent. FW you do
`noi furnish ihe requested informaiion, the U.S. Patent and Trademark Office may not be able to
`process and/or examine your submission, which may result in termination of proceedings or
`abandonment of the application or expiration of the patent.
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`The information provided by you in this form will be subject ta the following routine uses:
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`1. The information on this form wil be treated confidentially to ihe extent allowed under the
`Freedom of Information Aci (5 U.S.C. 552) and the Privacy Aci (5 U.S.C 552a). Recards fram
`this system of records may be disclosed to the Department of Justice to determine whether
`disciosure of these records is required by the Freedomof Information Act.
`A record from this system of records may be disclosed, as a routine use, in the course of
`presenting evidence fo a cour, magistrate, or administrative tribunal, including disclosures to
`oppasing counsel in ihe course of settlement negotiations.
`A record in this system of records may be disclosed, as a routine use, to a Member of
`Congress submitting @ request involving an individual, fo whom the record perlains, when the
`individual has requested assistance from ihe Member with respect io the subject matter of the
`record,
`A record in this system of records may be disciosed, as a routine use, io a contracior of the
`Agency having need for the information in order to perform a contract. Recipienis of
`information shall be required to comply with the requirements of the Privacy Act of 1974, as
`amended, pursuantio 5 U.S.C. 552a(n.
`A record related to an International Application filed under the Patent Cooperation Treaty in
`this system of records may be disclosed, as a routine use, to the Intemational Bureau of the
`World Intellectual Properly Organization, pursuant io the Faient Cooperation Treaty.
`A record in this system of records may be disclosed, a5 a routine use, to another federal
`agency for purpases of National Securily review G5 U.S.C. 184) and for review pursuant to
`the Atomic Eneray Act (42 U.S.C. 218ie)).
`A record from this system of recards may be disciosed, as a rouline use, to the Administrator,
`General Services, or his/her designee, during an inspection of records conducted Dy GSA as
`part of that agency’s responsibility to recommend improvements in records management
`practices and programs, under authorily of 44 U.S.C. 2904 and 2906. Such disclosure shall
`be made in accordance with the GSA regulations governing inspection of records for this
`purpose, and any other relevant (Le., GSA or Commerce) directive. Such disclosure shall not
`be used to make determinations about individuals.
`A record fram thts system of records may be disclosed, as a routine use, to the public after
`either publication of ihe application pursuant fo 35 U.S.C. 122(b} or issuance of a patent
`pursuant io 35 U.S.C. 151. Further, a record may be disclased, subject to ine limitations of 37
`CFR 1.14, as a routine use, to the public if the record was filed in an application which
`became abandoned or in which ihe proceedings were terminated and which application is
`referenced by either a published application, an application open io public inspection or an
`issued patent.
`A record from thts system af records may be disclosed, as a rouline uss, fo a Federal, Siate,
`or local law enforcement agency, ifihe USPTO becomes aware of a violation or potential
`violation of law or requiation.
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