`EIIeCIIve October 1, 2003
`
`
`OTHER THAN
`SMALL ENTITY
`CLAIMS AS FILED - PART'
`oI:.‘ SMALLENTITY
`TYPE I:
`ICqumnTI
`(Column 21
`.
`.
`
`
`
`m—— -- -
`
`
`
`
`
`
`L
`
`
`
`- my
`
`
`v
`
`V” V
`
`MULTIPLE DEPENDENT‘CLAIM pRESEN
`
`E
`-
`
`
`— ~
`
`'.
`
`0R TOTAL VI/II
`
`r LAIMS As AMENDED - PART II
`omen I-I‘ V
`
`
`(Column 2)
`SMALL ENTITY OR SMALL ENTITY
`
`REMAINING
`”‘GHEST
`ADDI-
`ADDI-
`NUMBER
`
`AFTER '
`PREVIOUSLY
`
`RATE
`TIDNAL
`TIONAL
`RATE
`PAID FOR
`I=EE
` 1'"m
`
`
`ICqumn 3)
`
`‘chumn 3I
`ICqumn II
`
`CLAIMS
`
`HIGHEST
`
`
`NUMBER
`
`
`PREVIOUSLY
`EXTRA
`
`PAID FOR
`
`
`
`
`
`REMAINING
`AFTER
`AMENDMENT
`
`
`
` --
`
`AMENDMENT5
`
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM D
`
`'
`
`RATE
`
`ADDI-
`TIONAL
`FEE
`
`-
`
`RATE
`~
`
`ADDI~
`TIONAL
`FEE
`
`OOI)3) i58
`
`II
`
`
`
`.
`TOTAL
`
`ADDIT. FEE
`
`
`'
`CLAIMS
`
`
`
`
`ADDI.
`ADOI-
`-
`REMAINING .
`TIONAL
`RATE
`TIONAL
`RATE
`PREVIOUSLY ‘
`AFTER
`
`
`
`
`PAID FOR FEEAMENDMENT E
`
`
`
`'
`
`.
`
`'
`
` . FIRST PRESENTATION OF MULTIP LE DEPENDENT CLAIM
`
`
`l
`
`
`
`0'o33I
`
`'a
`-. TOTAL
`II the entry In column I Is Iess man the army in column 2. mile '0‘ In Euumn-a.
`'
`T T
`OR AODITOFENE.
`ADUIT FEE
`“ II me 'HIgnest NumDEI Prewoust Paid For' IN THIS SPACE Is less than '20'. mm ’20.‘
`h
`'
`"'31 [he 'Higncst Number Plevnously Paid Fat’ IN THIS SPACE Is I955 than 3. enter '3.‘
`.- The_ ’Highesl NumDEI Prevxously Paid Fm' (7013! or Independent) Is the highs Rumba Iound In the appcopnate box In (:0an I.
`
`'
`
`FORM P7047:
`
`Iflev 10:03? '
`
`Faxem ana "warmth 09mm}; 5‘ DEPARTMENT OF COMMERCE
`
`