Doc Code: MES.GIB
`DocumentDescription: Certification of Micro Entity Status (Gross Income Basis)
`
`PTO/SB/15A (07-14)
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`CERTIFICATION OF MICRO ENTITY STATUS
`(GROSS INCOME BASIS)
`Application Number or Control Number(if applicable):
`Patent Number (if applicable):
`
`First Named Inventor:
`
`Title of Invention:
`
`The applicant hereby certifies the following—
`
`(1) SMALL ENTITY REQUIREMENT- The applicant qualifies as a small entity as defined in
`37 CFR 1.27.
`
`(2) APPLICATION FILING LIMIT — Neither the applicant nor the inventor nor a joint inventor has
`been namedasthe inventoror a joint inventor on more than four previously filed U.S. patent
`applications, excluding provisional applications and international applications under the Patent
`Cooperation Treaty (PCT) for which the basic national fee under 37 CFR 1.492(a) was not paid,
`and also excluding patent applications for which the applicant has assigned all ownership rights,
`or is obligated to assign all ownership rights, as a result of the applicant’s previous employment.
`
`(3) GROSS INCOME LIMIT ON APPLICANTS AND INVENTORS- Neither the applicant nor the
`inventor nor a joint inventor, in the calendar year preceding the calendar year in which the
`applicable fee is being paid, had a gross income, as defined in section 61(a) of the Internal
`Revenue Code of 1986 (26 U.S.C. 61(a)), exceeding the “Maximum Qualifying Gross Income”
`reported on the USPTO Website at hito:/Awww.uspto.gov/patents/law/micro_entity.isp which is
`equal to three times the median household income for that preceding calendar year, as most
`recently reported by the Bureau of the Census.
`
`Signature
`
`SIGNATURE byan authorized party set forth in 37 CFR 1.33(b)
`/Vance V. VanDrake, III/
`
`
`
`(4) GROSS INCOME LIMIT ON PARTIES WITH AN “OWNERSHIP INTEREST” — Neither the
`applicant nor the inventor nor a joint inventor has assigned, granted, or conveyed, nor is under an
`obligation by contract or law to assign, grant, or convey, a license or other ownership interest in
`the application concerned to an entity that, in the calendar year preceding the calendar year in
`which the applicable fee is being paid, had a gross income, as defined in section 61(a) of the
`Internal Revenue Code of 1986, exceeding the “Maximum Qualifying Gross Income” reported on
`the USPTO Website at htto://www.uspto.gov/patenis/law/micra entity.iso which is equal to three
`times the median household income for that preceding calendar year, as most recently reported
`by the Bureau of the Census.
`
`There is more than one inventor and | am one ofthe inventors who arejointly identified as the applicant. The required
`additional certification form(s) signed by the other joint inventor(s) are included with this form.
`
`Name
`
`Vance V. VanDrake, III
`
`
`
`ee—__22, 2015_|Telephone|513-698-5158|RegistrationNo. _|50,459
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`

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