`
`
`
`BASIC FEE
`(37 CFR 1.16(a), (b), or (c))
`SEARCH FEE
`(37 CFR 1.16(k), (i), or (m))
`EXAMINATION FEE
`(37 CFR 1.16(0), (p), or (q))
`
`TOTAL CLAIMS
`(37 CFR 1.16())
`INDEPENDENT CLAIMS
`(37 CFR 1.16(h))
`
`
`
`
`NIA
`
`NIA
`
`NIA
`
`NIA
`
`N/A
`
`minus 20
`
`
`
`
`If the specification and drawings exceed 100
`sheets of paper, the application size fee due is
`APPLICATIONSIZE
`$270 ($135 for small entity) for each additional
`FEE
`(37 CFR 1.16(s)}
`50 sheets or fraction thereof. See
`35 U.S.C, 41(a)(1)(G) and 37 CFR
`PsLe
`MULTIPLE DEPENDENT CLAIM PRESENT(37 CFR 1.160)
`
`
`* Ifthe difference in column 1 is less than zero, enter"0" in column2. TOTAL|462|TOTAL P|
`
`Filing Date:
`
`11/26/08
`
`PTO/SB/06 (12-04)
`Approved for use through 7/31/2006. OMB 0651-0032
`U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
`Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unlessit displays a valid OMB control number.
`PATENT APPLICATION FEE DETERMINATION RECORD
`Application or Docket Number
`Substitute for Form PTO-875
`12/324.122
`
`
`
`APPLICATION AS FILED — PART|
`(Column 1)
`
`(Column2)
`
`SMALL ENTITY
`
`RATE(5)
`NIA
`
`FEE($)
`
`OR
`
`OTHER THAN
`SMALL ENTITY
`
`RATE($)
`NIA
`
`FEE($)
`
`
`
`NR ~loO fi
`
`N.
`
`NIA
`
`OR
`
`|
`
`
`
`N/A
`
`N/A
`
`$26
`
`*
`$110
`
`x
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`mo
`5
`OR
`Total
`=
`©|(37 CFR 1.16())
`
`© [Independent
`s|(97 CFR 1.16(h) OR
`
`
`|Application Size Fee (37 CFR 1.16(s)) FY Fs
`
`
`
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENTCLAIM (37 CFR 1.16())
`OR
`NIA
`
`TOTAL
` ADD'T FEE
`
`
`
`If the entry in column 1 is less than the entry in column 2, write “0° in column 3.
`*
`If the “Highest Number Previously Paid For’ IN THIS SPACE is less than 20, enter “20°.
`**
`
`
`** If the "Highest Number Previously Paid For’ IN THIS SPACE is less than 3, enter “3”.
`
`
`Ine “Highest Number Previously Paid tor (1 otal or Independent) is the highest numberfound in the appropnate box in column 1.
`
`
`This collection of information is required by 37 CFR 1.16. The information is required to obtain or retain a benefit by the public whichis tofile (and by the
`USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.14. This collection is estimated to take 12 minutes to complete,
`including gathering, preparing, and submitting the completed application form to the USPTO. Timewill vary depending uponthe individual case. Any comments
`on the amountof time you require to completethis form and/or suggestions for reducing this burden, should be sentto the Chief Information Officer, U.S. Patent
`and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMSTO THIS
`ADDRESS.
`SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
`
`APPLICATION AS AMENDED- PARTI!
`
`(Column 2)
`HIGHEST
`NUMBER
`
`
`
`
`(Column 3)
`
`PRESENT
`EXTRA
`
`SMALL ENTITY
`
`OR
`
`OTHER THAN
`SMALL ENTITY
`
`RATE($)
`
`RATE(8)
`
`(Column 1)
`CLAIMS
`
`REMAINING
`<
`AFTER
`
`5
`AMENDMENT
`OR
`Total
`Ww
`&|37 cFr 1.160)
`=|Independent
`= (37 CFR 1.16(h))
`OR
`
`<|Application Size Fee (37 CFR 1.16(s)) PY Po
`
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENTCLAIM (37 CFR 1.16(j))
`NIA
`OR
`N/A
`
`TOTAL
`OR ADD'T FEE
`
`ADD'T FEE
`
`
`
`
`
`
`
`(Column 1)
`CLAIMS
`REMAINING
`AFTER
`AMENDMENT
`
`(Column 2)
`HIGHEST
`NUMBER
`PREVIOUSLY
`PAID FOR
`
`(Column 3)
`
`PRESENT
`EXTRA
`
`
`
`RATE(8)
`
`
`
`OR
`
`RATE(8)
`
`TOTAL
`ADD'T FEE
`
`
`OR
`
`
`if you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.
`
`