AME (Last, First, Middle initial)



  

 

UNIVERSITY OF CALIFORNIA AEOTE PSSPAREYDR
. STATE OATH OF 
. ?ll-'91, PATENT ACKNOWLEDGMENT 

5?0220 Titus?.130? 

         
           
        
 

           
 
 
 
  
  
   
 


Taken?an?d Ellisc?be?d Efae me on: Lfo Z7 03 Officer or (13/

_Sign_ature_0f_ 
Authorized Of?cial: M- NOTE: No fee may be charged for administering t_hiEO_ath. 
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members
Recents to administer such oaths 
?ll?persons (other than aliens) employed by WHERE OATHS ARE The Oaths of all employees of the University shall
the University, in common with all other California public employees, whether be filed with the Campus Accounting Office.



XX, Section 2, Calif. Government Codes, Sections 3100-3102.) TO OATH: No compensation for service performed prior to his
subscribi 

persons re-employed by the University after a tennlnatlon 0f sewlce must no reimbursement for expenses incuned may be paid prior to his subscribing to
a new Oath if the date of re-employment is more than one year after the the Oath or affirmation (Calif Government Code section 3107 
date on which the previous Oath was signed (Calif.Govemment Code. 
Section 3102)? PENALTIES: "Every person who, while taking and subscribing to the Oath or

WHEN OATH MUST BE The Oath must be signed BEFORE the af?rmation required by this chapter, states as true any material which he knows to
individual enters upon the duties of employment (Calif. Constitution, Article be false, is guilty of perjury, and is punishable by imprisonment in the state prison
XX, Section 3: Calif. Government Code Section 3102.) not less than one or more than 14 years." (Calif. Government Code, Section 3108.)

PATENT ACKNOWLEDGMENT . . . . . . . .
This acknowledgment is made by me to The Regents of the University of Sha? fumlsh w'th
California, a corporation, hereinafter called ?University," in part consideration 
of my employment, and of wages and/or salary to be paid to me during any in the event any such invention shall be deemed by University to be patentable or
period of my employment, by University, and/or my utilization of University protectable by an analogous property right, and University desires. pursuant to
research facilities and/or my receipt of gift, grant, or contract research funds determination by University as to its rights and equities therein, to seek patent or
through the University. analogous protection thereon, shall execute any documents and do all things
By execution of this acknowledgment, i understand that i am not waiving any expense, to_ a55lgn.to all rights, title, and
12$??ng rehgf??fsg?g forth thereon. The scope of this provision is limited by California Labor Code section
y, y. 2870, to which notice is given below. in the event protest the University's

i also understand and acknowledge that the University has the light to determination regarding any rights or interest in an invention, acknowledge my
change the Policy from time to time, including the percentage of net royalties obligation: to proceed with any University requested assignment or assistance;
paid to inventors, and that the policy inleffect' at the time an invention is to give University notice of that protest no later than the execution date of any of
disd959d ?hall govern the University?s diSPOSi?on 0f royalties, if any, the above-described documents or assignment; and to reimburse University for
that lnventlon. Further, acknowledge that the_percentage 0? "Bl royalties all expenses and costs it encounters in its patent application attempts, if any such
paid to inventors ls denved only from conSIderatlon tn the form of money or protest is subsequently sustained or agreed to.

equity received under: 1) a license or bailment agreement for licensed rights,

or 2) an option or letter agreement leading to a license or bailment agreement. acknowledge that i am bound to do 3" things necessary to enable University to
i also acknowledge that the percentage of net royalties paid to inventors is not perform its obligations to grantors of funds for research or contracting agencies as
derived _from- research -funds?er?from any?other?consideration-of?any kind? said 
received by the University. The Policy on Accepting Equity When Licensing . . . . . . . . . .
University Technology governs the treatment of equity regeived in may rellanlsh to me all or a part of its to any such lnventlon, lf, ln

consideration for a license. its judgment, the criteria set forth in the Policy have been met.

acknowledge my obligation to assign inventions and patents that conceive acknowledge that i am bOUFid during any periods of employment by University or
or develop while employed University or during the course of my utilizatjon for any period during conceive or develop any invention during the course
of any University research acilities or any connection with my use of gift, of my utilization of any University research facilities, or any gift, grant, or contract
grant, or contract research funds received through the University. further research funds received through the Universi 

acknowledge my Wagon to report and fully disclose the

   
  

   
    

     
  
          
       
      
 
  
   

   
  
  
  
  
  

    
   
  
     
        
   
        
        
         
       
  
     
    
     
   
     
    
  
      
      
          
    
       
      
  
    
    
   
  
 

   
 
 

the Of?ce of Technology
inventions shall be examin

  

   

RETENTION: Accounting: 5 years after 
separation, except in cases of disability, Employee/Guest Name (Pleas 

retirement or disciplinary action, in which .
0 Employee/Guest Signa .

cases retain until age 7 . . .
Witness Signature: 9 16?5?

Other Copies: 0~5 years after separation.