`Approved for use through 7/31/2006. OMB 0651-0032
`U.S. Patént and Trademark Office; U.S. DEPARTMENT OF COMMERCE
`Under the Paperwork Reduction Act of 1995, no persons are required to respondto a collection of information unless it displays a valid OMBcontrol number.
`
`
`PATENT APPLICATION FEE DETERMINATION RECORD
`Application or Docket Number
`
`Substitute for Form PTO-875
`11.680.452
`
`
`
`APPLICATION AS FILED — PART|
`(Column 1)
`
`(Column 2)
`
`SMALL ENTITY
`
`
`OR
`
`OTHER THAN
`SMALL ENTITY
`
`Eee|(37 CFR 1.16(a), (b), or(c))
`i(37 CFR 1.16(k), (i), or (m))
`EXAMINATION FEEeeee|
`TOTAL CLAIMS
`(37 CFR 1.16(i))
`35
`minus 20 =
`INDEPENDENT CLAIMS
`
`If the specification and drawings exceed 100
`sheets of paper, the application size fee due is
`APPLICATION SIZE
`
`
`FEE
`$250 ($125 for small entity) for each additional
`(37 CFR 1.16(s))
`50 sheets orfraction thereof. See
`
` 35 U.S.C. 41(a)(1)(G) and 37 CFR
`
`MULTIPLE DEPENDENT CLAIM PRESENT(37 CFR 1.16(j))
`* If the difference in column 1 is less than zero, enter "0" in column 2.
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
` (Column 1).
`EXTRA
` AMENDMENTB
`
`RATE ($
`
`FEE ($
`
`OR
`
`—
`X$50=
`_
`
`NIA
`
`TOTAL
`
`OR
`
`OTHER THAN
`SMALL ENTITY
`
`RATE($)
`
`.
`
`APPLICATION AS AMENDED - PARTIl
`:
`(Column 2)
`HIGHEST
`NUMBER
`PREVIOUSLY
`
`(Column 3)
`
`PRESENT
`EXTRA
`
`(Column 1)
`CLAIMS
`REMAINING
`AFTER
`<
`AMENDMENT
`5
`OR
`.
`Total
`WwW
`2|(37 CFR 1.160)
`2|Independent
`S [97 cFR 1.160)
`OR
`<|Application Size Fee (37 CFR 1.16(s)) fF
`
`
`
`FIRST. PRESENTATION OF MULTIPLE DEPENDENTCLAIM (37 CFR 1.16(j))
`OR
`N/A
`TOTAL
`OR ADD'T FEE
`
`CLAIMS
`REMAINING
`AFTER
`AMENDMENT
`
`(Column 2)
`HIGHEST
`NUMBER
`PREVIOUSLY
`PAIO FOR
`
`(Column 3)
`
`PRESENT
`
`Total
`
`(
`Independent
`
`:
`
`.
`
`Application Size Fee (37 CFR 1.16(s))
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENTCLAIM (37 CFR 1.18(j))
`
`
`ADD'T FEE
`
`
`
`
`*
`If the entry in column 1 is less than the entry in column 2, write “O” in column 3.
`
`
`If the “Highest Number Previously Paid For’ IN THIS SPACE is less than 20, enter *20”.
`“*
`“If the “Highest Number Previously Paid For’ IN THIS SPACE is less than 3, enter “3”.
`
`
`The “Highest NumberPreviously Paid For’ (Total or Independent) is the highest numberfoundin the appropriate Doxin column 1.
`
`This collection of information is required by 37 CFR 1.16. The information is required to obtain or retain a benefit by the public whichis to file (and by the
`USPTOto process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.14. This collection is estimated to take 12 minutes to complete,
`including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending uponthe individual case. Any comments
`on the amountof time you require to complete this form and/or suggestions for reducing this burden, should be sentto the Chief Information Officer, U.S. Paten
`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: Commissionerfor Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
`
`if you need assistance in completing the form, call 1-800-PTO-9199 and selectoption 2.
`
`
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