`(Cmumn1)
`
`
`
`(Cowmn2l
`
`lIc'atIon OrDocke: Number
`
`
`
`
`
`
`
`
`
`-
`
`
`PATENT APPLICATION EEE DETERMINATION RECORD
`EffeCtive October 1, 2003
`k 19 I 49 0 6 47 I
`
`
`
`
`
`SMALL ENTITY
`OTHER THAN
`TYPE
`[:2]
`OP] SMALLENTHY
`
`
`
`
` S
`
`
`
`
`
`
`
`
`
`
`
` O 1)I
`
`
`D I
`~
`MULTIPLE DEPENDENTCLAIM PRESEN
`" -- 290= -
`V
`
`
`.II the dlflerence In column 1 Is less~than zero. enter 0 In column 2
`TOTAL
`OR TOTAL m‘l
`
`
`CLAIMS AS AMENDED - PART II
`omen H- "
`
`(Column 1)
`(Column 2)
`SMALL ENTITY OR SMALL ENT'TY
`
`
`
`CLAIMS
`HIGHEST
`ADDI-
`
`
`
`
`
`REMAINING
`NUMBER
`
`
`
`
`PREVIOUSLY
`AFTER '
`T'ONAL
`PAID FOR
`AMENDMENT
`FEE
`
`
`
`
`
`
`2. --m_— -- OR
`--
`
`
`
`< FIRST PRESENTATION OF-MULTIPLE DEPENDENT CLAIM
`[:1
`
`
`
`
`
`
`
`X86:
`
`
`
`
`
`
`
`TOTAL
`TOTAL
`OR ADDIT. FEE
`ADDIT. FEE
`Column 2)
`Column 3)
`
`HIGHEST
`-
`
`NUMBER
`pnesgN-r
`-
`ADD"
`ADDI-
`PREVIOUSLY
`RATE
`TIONAL
`RATE
`TIONAL
`
`PAID FOR
`FEE
`FEE
`
`.
`
`
`
`»
`
`
`
`ADDI-
`TIONAL
`FEE
`
`
`(Column 3)
`
`A
`PRESENT
`
`EXTRA
`
`RATE
`
`RATE
`
`sta:
`
`xCD‘I’
`
`..+290=_
`
`_
`
`TOTAL
`ADDIT. FEE
`
`,
`RATE
`
`ADDI-
`TIONAL
`
`'
`
`RATE
`
`X$18=
`
`+290:
`
`V
`
`,
`
`.
`
`(Column 1)
`CLAIMS
`REMAINING
`AFTER
`AMENDMENT
`
`REMAINING .
`AFTER
`AMENDMENT
`
`HIGHEST
`
`NUMBER
`PREVIOUSLY
`PAID FOR
`
`
`
`
`
`
`
`
`
`
`
`
`<
`E
`u,
`
`2 L
`
`u
`
`a:
`p.
`.”
`
`ZI
`
`2Q
`
`.21»;u:
`
`E(
`
`A
`
`O.
`
`-2D
`
`JED2L
`
`u2<
`
`
`
`TOTAL
`II the entry in column I Is less than the entry in column 2. write '0' in Column -3.
`'
`' ADDIT. FEE
`" It the 'HIghest Number Prewously Paid For' IN THIS SPACE is less than '20'. enter '20“
`.
`'“II the 'Highest Number Prewously Paid For" IN THIS SPACE is less than 3. enter '3.’
`.' The_’Highesl Number Prewously Paid For" (Total or Independent) is the highest number (ound in the appropuate box In column I.
`
`'
`
`
`
`FOR PTO~87$
`(Rev 10:03} ‘
`Patent and Trademark Office-Q 5. DEPARTMENT OF COMMERCE
`
`t
`
`
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