PATENT APPLICATION FEE DETERMINATION RECORD
`Substitute for Form PTO-875
`
`Application or Docket Number
`13/269,234
`
`Filing Date
`
`LC To be Mailed
`
`OTHER THAN
`APPLICATION AS FILED — PART|
`SMALL ENTITY
`OR
`SMALL ENTITY X]
`(Column 2)
`(Column 1)
`
`POR NMecnrico[wimeeneoraJLrwrea] ee © ©
`
`
`
`37 GFR 1.16(a),
`
`(b), or
`
`(¢
`
`37 CFR 1.16(k), (i), or
`
`(m
`
`(37 CFR 1.16(0
`TOTAL CLAIMS
`37 CFR 1.16
`INDEPENDENT CLAIMS
`37 CFR 1.16(h
`
`Oo
`
`APPLICATIONSIZE FEE
`(37 CFR 1 16(s))
`
`minus 20 =
`.
`minus 3 =
`
`.
`
`If the specification and drawings exceed 100
`sheets of paper, the application size fee due
`is $250 ($125 for small entity) for each
`additional 50 sheets orfraction thereof. See
`35 U.S.C. 41(a)(1)(G) and 37 CFR 1.16(s).
`
`[_] MULTIPLE DEPENDENTCLAIM PRESENT(37 CFR 1,16(j)
`* If the difference in column 1 is less than zero, enter “O” in column 2.
`
`APPLICATION AS AMENDED - PARTII
`
`REMARING S| ee ROQITIONAL
`
`(Column 3)
`
`SMALL ENTITY
`
`OR
`
`SMALL ENTITY
`
`OTHER THAN
`
`MODITIONAL
`
`PTO/SB/06 (07-06)
`Approved for use through 1/31/2007. OMB 0651-0032
`U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
`Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.
`
`The “Highest Number Previously Paid For’ (Total or Independent) is the highest numberfound in the appropriate box in column 1.
`
`(Column 1)
`CLAIMS
`
`(Column 2)
`HIGHEST
`
`AMENDMENT
`
`PAID FOR
`
`LC] Application Size Fee (837 CFR 1.16(s))
`
`Cc FIRST PRESENTATION OF MULTIPLE DEPENDENTCLAIM (37 CFR 1.16(j))
`
`oa
`
`ZL
`
`u =aZL
`
`u =<
`
`x
`
`(Column 1)
`CLAIMS
`REMAINING
`AFTER
`
`(Column 3)
`
`(Column 2)
`HIGHEST
`NUMBER
`PREVIOUSLY
`
`es PAID FOR
`
`1.16(i
`
`37 CFR 1.16(h
`
`CL] Application Size Fee (837 CFR 1.16(s))
`
`CT FIRST PRESENTATION OF MULTIPLE DEPENDENTCLAIM (37 CFR 1.16(j))
`
`AMENDMENT
`
`ADDITIONAL
`FEE ($)
`
`ADDITIONAL
`FEE ($)
`
`* If the entry in column 1 is less than the entry in column2, write “O” in column 3.
`** If the “Highest NumberPreviously Paid For” IN THIS SPACEis less than 20, enter “20”.
`*** If the “Highest Number Previously Paid For’ IN THIS SPACEis less than 3, enter “3”.
`
`Legal Instrument Examiner:
`/STELLA LITTLE/
`,
`
`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 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 upontheindividual case. Any comments on the amountof time you
`require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S. Patent and TrademarkOffice, U.S.
`Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMSTO 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 select option 2.
`
`