PTO/SB/06 (09-11)
`Approved for use through 1/31/2014. OMB 0651-0032
`U.S. Patent and Trademark Office; U.S. DEPARTMENT OF GOMMERCE
`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[|pplication or Docket Number Filing Date
`
`Substitute for Form PTO-875
`14/1 95,435
`03/03/2014
`CT To be Mailed
`
`APPLICATIONAS FILED — PART|
`
`(Column 1)
`
`(Column 2)
`
`Entity:
`
`[|] LARGE &X] smatt [] micro
`
`37 GFR 1.16(a),
`
`(b), or
`
`(¢
`
`37 GFR 1.16(k), (i), or
`
`(m
`
`LC] EXAMINATION FEE
`
`TOTAL CLAIMS
`37 CFR 1.161
`INDEPENDENTCLAIMS
`37 CFR 1.16(h
`
`LJAPPLICATION SIZE FEE
`(37 CFR 1.16(s))
`
`.
`
`.
`
`[_] MULTIPLE DEPENDENT CLAIM 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
`
`(Column 1)
`
`(Column 2)
`
`(Column 3)
`
`CLAIMS
`
`HIGHEST
`
`REMAINING p SREOUSLY
`
`AMENDMENT
`
`PAID FOR
`
`PRESENTEXTRA
`
`=5
`
`=
`
`ADDITIONALFEE($)
`
`.
`minus 20 =
`.
`minus 3 =
`If the specification and drawings exceed 100 sheets
`of paper, the application size fee due is $310 ($155
`for small entity) for each additional 50 sheets or
`fraction thereof. See 35 U.S.C. 41(a)(1)(G) and 37
`
`The “Highest NumberPreviously Paid For” (Total or Independent) is the highest number found in the appropriate box in column 1.
`
`AMENDMENT
`
`AMENDMENT
`
`[_] Application Size Fee (37 CFR 1.16(s))
`
`Cc FIRST PRESENTATION OF MULTIPLE DEPENDENTCLAIM (37 CFR 1.16(j))
`
`(Column 1)
`
`CLAIMS
`REMAINING
`AFTER
`AMENDMENT
`
`(Column 2)
`
`HIGHEST
`NUMBER
`PREVIOUSLY
`PAID FOR
`
`(Column 3
`
`)
`
`PRESENT EXTRA
`
`1.16(i
`Independent
`.
`creme Pp MinesPe
`[_] Application Size Fee (37 CFR 1.16(s))
`
`CT FIRST PRESENTATION OF MULTIPLE DEPENDENTCLAIM (37 CFR 1.16(j))
`
`* |f the entry in column 1 is less than the entry in column 2, write “O” in column 3.
`** If the “Highest NumberPreviously Paid For’ IN THIS SPACEis less than 20, enter “20”.
`*** If the “Highest NumberPreviously Paid For’ IN THIS SPACEis less than 3, enter “3”.
`
`LIE
`VIKKI GRAY/
`
`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 upon the individual case. Any comments on the amountoftime 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 FORMS TO THIS
`ADDRESS. SEND TO: Commissioner for 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.
`
`