\v'
`
`PTO/S BIOS (12-04)
`
`Date:
`
`08/26/10
`
`(Column 2)
`NUMBER EXTRA
`NIA
`
`SMALL ENTITY
`RATE (3)
`FEE (3)
`NlA
`
`OR
`
`Approved for use through 7/31/2006. OMB 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
`(Applicafim 0' °°°kel Number
`
`1 2/869 235 Substitute for Form PTO-875
`
`
`APPLICATION AS FILED — PART I
`OTHER THAN
`SMALL ENTITY
`(Column 1)
`“ NUMBER FILED
`RATE (5)
`FEE (3)
`N/A
`N/A
`
`
`
`
`
`
`
`
`
`
`
`
`
`N/A
`
`x$220
`
`TOTAL
`
`OTHER THAN
`
`SMALL ENTITY
`
`
`ADDI-
`
`
`TIONAL
`
`RATE ($)
`
`
`
`ADDI-
`TIONAL
`FEE (S)
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`(Column 1)
`CLAIMS
`REMAINING
`AFTER
`AMENDMENT
`
`(Column 2)
`HIGHEST
`NUMBER
`PREVIOUSLY
`PAID FOR
`
`(Column 3)
`
`PRESENT.
`EXTRA
`
`RATE (5)
`
`
`
`AMENDMENT8
`
`Total
`(37 CFR 1.16(i))
`Independent
`(37 CFR 1.16(h))
`Application Size Fee (37 CFR 1.16(s))
`
`NlA
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.160))
` OR
`WA
`.49.>'—
`TOTAL
`OR >UU.1 'nmrn
`ADD'T FEE
`
`O21
`
`O:0
`
`OR
`
`RATE ($)
`
`ADDI-
`TIONAL
`FEE (5)
`
`It 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, U.S. 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. P.O. Box 1450, Alexandria, VA 22313-1450.
`
`Ifyou need assistance in completing the form, call 1-800-PTO-9199 and select option 2.
`
`
`
`
`
`
`N/A
`
`X$110
`
`TOTAL
`
`SMALL ENTITY
`‘
`ADDI-
`TIONAL
`
`RATE (3)
`
`TOTAL
`ADD'T FEE
`
`0II
`
`OR
`
`°
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`'
`
`N/A
`
`N/A
`
`
`
`
`
`(37 CFR 1.16(i))
`
`INDEPENDENT CLAIMS
`
`(37 CFR 1.16(h))
`
`If the specification and drawings exceed 100
`APPLICATION SIZE
`sheets of paper. the application size lee due is
`
`FEE
`$270 ($135 for small entity) for each additional
`
`50 sheets or fraction thereof. See 35 U.S.C.
`
`(37 CFR 1.16(s))
`
`41(a)(1)(G) and 37 CFR
`
`_
`
`
`
` MULTIPLE DEPENDENT CLAIM PRESENT (37.CFR 1.16(j))
`
`" If the difference in column 1 is less than zero. enter "0" in column 2.
`
`— PART II
`
`D
`APPLICATION AS AMEN ED
`(Column 1)
`(Column 2)
`HIGHEST
`CLAIMS
`
`
`REMAINING
`NUMBER
`
`
`PAID FOR
`
`
`
`(COIumn 3)
`
`PRESENT
`
`<
`z
`_ °R _-
`ma.
`I”
`E (37 CFR 1.16(i))
`_ _-
`z '"depemem
`OR
`g (37 CFR1.16(h))
`
` < Application Size Fee (37CFR1.16(5» . — ——
`
`
` FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.16(j))
`0R _
`R
`TOTAL
`ADD'T FEE
`
`