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`SIGNATURE of Assignee of Record
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`+81-53-584-0200 Telephone +
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`Name Akifumi TAKEDA
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`148G, Afexandria, VA 22413-1450.
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`Privacy Act Statement
`
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`ction with your
`The Privacy Act of 1974 (P.L. 93-878) requires that you be given certain information in cor
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`submission of the attached form related 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 this information is
`S35 LSC. 2(by2): (2) furnishing of the information solicited is voluntary; and (3) the principal purpese for which
`the information is used by ihe LLS. Patent and Trademark Officeis to process and/or examine your submission
`related to a patent application or paiant.
`if you co mot furnish the requested information, 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 apgiication or expiration of the patent.
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`Y¥
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`The information provided by you in this form will be subject to the following routine uses:
`
`The information on this form will be treated confidentially to the extent alowed under the Freedom of
`information Act (5 U.S.C. 552) and the Privacy Aot (5 U.S.C 5528). Records from this system of records
`may be disclosed to the Department of Justice to determine whether disclosure of these records is
`required by the Freeciorn of Information Act.
`A-record from this system of records may be disclosed, as a routine use, in the course of presenting
`evidance to a court, magistrate, or administrative tribunal, including disclosures to opposing counselir
`the course of seftillement negotiations.
`of Congrass
`ia a Mamber
`A record in this avstem of racords may be disclosed, as a routine usa,
`suomitiing a request invalving an individual,
`to whom the record pertains, when the individual has
`requested assistance from the Mamber with respect fo the subject matter of the record.
`A record in this system of records may be disclosed, as a routine use, to a contractor of the Agency
`having need for the informationin orderto perforrn a contract. Recipients of information shail be requirac
`to comply with the requirements of the Privacy Act of 1974, ag amended, pursuant to 5 U.S.C. 552airn).
`A record related to an international Aoplicationfiled under the Patent Coaperation Treaty in this system
`of records may be disclosed, as a routine use, to the International Sureau of the World Intellectual
`Property Organization, pursuant to the Patent Cooperation Treaty.
`A record in this system of records may be disclosed, as a routine use, to another federal agencyfor
`purposes of National Security review (35 U.S.C. 1814) and for reviewpursuant to the Atomic Energy Act
`(42 U.S.C, 218ic)}.
`A record from this systera of records may be disclosed, as a routine use, fo the Administrator, General
`Services, or his/her designee, during an inspection of records conducted by GSA as pari afthet agency's
`
`responsidility fo recommend improvements in records management practices and programs, under
`authority of 44 ULS.C. 2864 and 2906. Such disclosure shall be made in accordance with the GSA
`ragulations governing inspection of records for this purpose, and any other relevant (ie., GSA or
`Cammerce} directive. Such disclosure shall not be used to make determinations about individuals.
`A record from this system of records may be disclosed, as a rautine use, to the pubic after either
`publication of the application pursuant to 35 U.S.C. 122{b} or issuance of a patent pursuant to 35 USC.
`
`151. Further, a record may be disclosed, subject to the limitations of 37 CFR 1.44, as 4 routine use, to
`if the record was filed in an application which becarns abandoned or in which the proceedings
`
`
`were terminated and which application is referenced by either a published application, an application
`open to public inspection or an issued patent.
`Arecard fram this system of records may be disclosed, as a routine use, to a Federal, State, or local law
`enforcement agency,
`if the USPTO becomes aware of a violation or potential violation cf faw or
`reguiation.
`
`

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