————, the above named Petitioner, residing at ————, being duly sworn, deposes and says, that he verily believes himself[p. 32] to be the original, first and sole inventor of the improvement in ————, described and claimed in the foregoing specification; that the same has not been patented to himself or to others, with his knowledge or consent, except in the following countries:——
| Country. | No. | Date of Patent. | Term of years. |
That the same has not, to his knowledge, been introduced into public use in the Hawaiian Islands for more than one year prior to his application for a Patent; and he does not know or believe that the same was ever before known or used; and that he is a citizen (or subject) of ————.
(Inventor's full Name.)
Sworn to and subscribed before me,
this ———— day of ————, A. D. 18—.
[L. S.] (Signature of Notary.)
(See Rule [23].)
NO. 4.—PETITION FOR CERTIFICATE OF COPYRIGHT BY AN AUTHOR.
To the Minister of the Interior:
Your Petitioner, ————, a citizen (or subject) of ————, residing at ————, prays that a Certificate of Copyright be issued to him for ———— (describe the article) ———— a copy whereof is filed herewith.