8/3/07
`
`PTO/SB/06 (12-04)
`-
`Approved for use through 7/31/2006. 0MB 0651-0032
`US. Patent and Trademark Office; US. DEPARTMENT OF COMMERCE
`Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.
`.
`PATENT APPLICATION FEE DETERMINATION RECORD
`- Substitute for Form PTO-875
`
`1 1 /833 , 853
`
`APPLICATION AS FILED— PART I
`(Column 1)
`
`(Column 2)
`
`SMALL ENTITY
`
`‘
`
`OTHER THAN
`SMALL ENTITY
`
`
`
`RATE ($)
`
`X
`
`'00'1II
`
`100=
`
`FEE (5)
`
`‘1
`
`RATE (5)
`
`FEE (S)
`
`o.
`
`:0
`
`or0ll
`
`X
`
`200=
`
`
`
`
`
`
`
`
`
`
`
`
`
`BASIC FEE
`___SEARCH FEE
`___EXAMINATION FEE
`___
`28——‘I
`TOTAL CLAIMS .
`INDEPENDENT CLAIMS
`—m—
`
`If the specification and drawings exceed 100
`APPLICATION SIZE
`sheets of paper, the application size fee due is
`
`
`FEE
`$250 ($125 for small entity) for each additional
`
`
`50 sheets or fraction thereof. See 35
`(37 CFR1.16(s)) ’
`
`u.s.c. 41(a)(1)(G) and 37 CFR 1.16(s).
` MULTIPLE DEPENDENT CLAIM PRESENT (37 CFR 1.160))
`“ If the difference in column 1 is less than zero, enter "0" In column 2.
`
`
`
`Ii
`
`
`N/A
`
`TOTAL
`
`725
`
`N/A
`
`TOTAL
`
`OTHER THAN
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
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`
`
`
`APPLICATION AS AMENDED — PART II
`.
`
`(Column 1)
`
`(Column 2)
`
`'
`
`(Column 3)
`
`.
`
`SMALL ENTITY
`
`OR
`
`CLAIMS
`REMAINING
`AFTER
`AMENDMENT
`
`HIGHEST
`NUMBER
`PREVIOUSLY
`PAID FOR
`
`PRESENT
`EXTRA
`
`_ X
`
`ADD]
`.
`’
`:2“?
`RATE (3)
`<
`I
`I
`’5
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`OR
`In
`Total
`- _-
`5 (Perm-1w»
`_
`_
`2 Independent
`X
`OR
`_
`_
`X
`g (37 CFR 1.16(h))
`
`< Applicationsuereewvcmuse»
`' — _—
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.160))
`WA
`OR
`WA _
`TOTAL
`TOTAL
`ADD'T FEE
`OR ADD'T FEE
`
`SMALL ENTITY
`
`ADDI-
`TIONA
`FEE (S)
`
`RATE (s)
`
`
`
`(Column 1)
`
`(Column 2)
`
`(Column 3)
`
`OR
`
`CLAIMS
`REMAINING
`AFTER
`AMENDMENT
`
`HIGHEST
`NUMBER
`PREVIOUSLY
`PAID FOR
`
`PRESENT
`EXTRA
`
`‘3
`'5
`Lu
`.
`Total
`2
`o (37 CFR 1.160))
`
`E Independent
`z (37 CFR1.16(h))
`
`< Application Size Fee (37 CFR 1.16(s))
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1160))
`
`RATE (5’
`
`.
`
`x
`
`X
`
`=
`
`=
`
`TOTAL
`
`ADD'T FEE,
`
`ADD]
`‘
`Egg/:-
`(
`)
`
`RATE (5)
`
`
`ADDI-
`TIONA
`FEE ($)
`
`OR
`
`OR
`
`x
`
`X
`
`=
`
`=
`
`_—
`OR —
`TOTAL
`
`0R ADD'T FEE
`
`If the entry in column 1 is less than the entry in column 2, write “0" 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 Number Previously Paid For" (Total or Independent) is the highest number found in the appropriate box in 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 which is to file (and by the
`USPTO to 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 upon the individual case. Any comments
`on the amount of time you require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, US. Patent
`and Trademark Office. US. Department of Commerce, PO. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS
`ADDRESS.
`SEND TO: Commissioner for' Patents, PO. Box 1450, Alexandria, VA 22313-1450.
`
`If you need assiStance in completing the form, call 1-800-PTO-9199 and select option 2.
`
`