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`PATENT APPLICATION FEE DETERMINATION RECORD
`Avoid-Ibo oroodror vaba
`' Substitute for Form PTO-875
`Ettective December 8. 2004
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`_
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`_ APPLICATION AS FILED - PART I
`(Colurm 1)
`(cum 2,
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`SMALL ENTITY
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`0R
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`OTHER THAN
`SMALL ENTITY
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`mesa
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`mm mm
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`BASIC FEE
`37CFR11-a,b.a c
`SEARCH FEE
`(37 CFR 1 1600. (I). or(m))
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`EXAMINATION FEE
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`NIA
`(37 C‘R I I6(0). (D). 0' (0))
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`TOTAL CLAIMS
`' C)
`(37 CPR 1 16(I))
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`minus 20 =
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`INDEPENDENT CLAIMS
`(37 (YR 1 1601))
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`Itthe pedncatlon and drawings exceed 100
`APPLICATION SIZE-
`sheets of paper. the application size tee due
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`FEE
`is $250 ($125 for small entity) for each
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`(37 (TR 1 16(8))
`additional 50 sheetsor traction thereot. See
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`35U.S.C. 41 a I G and37CFR1.1
` MULTIPLE DEPENDENT CLAIM PRESENT (37 CFR 1160))
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`"It the ditlerence in column 1 isles than zero,enler1)' in column 2.
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`, APPLICATION AS AMENDED - PART II
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`0R
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` AMENDMENTA‘'
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` ' (Column-1)
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`Column 2)
`Column 3)
`' HIGHEST
`PAID FOR
`NUMBER
`REMAINING
` .AMENDMENTB‘
`
`PREVIOUSLY '
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`(37C‘R 1.186)) -m--
`
`Independent
`5
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`(37 era 1. ram».
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`OTHERTHAN
`SMALL ENTITY
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` -
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`SMALL ENTITY
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`(Column 3)
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`PRESENT
`EXTRA
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`(Warm?)
`HIGHEST
`NUMBER
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`PREVIOUSLY
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`PAID FOR
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`-
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`(Column 1)
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` ~: CLAIMS
`REMAINING
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`AFTER
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`AMENDMENT
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`Total
`(37 cm Lieu»
`Independent
`.(37 cm Liam»
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`Application Size Fee (37 CFR 1.16(s))
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`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR new)
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`' CLAIMS
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`AppI'ImIIon Size Fee (37 CFR 1.16(s))
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`FIRST PRESENTATION OF MULTIPLE DB’ENDENT CLAIM (37 CFR 1.180)
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`ADD'L FEE
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`‘ It the entry in column 1 is less than the entry in column 2. write ‘’0" in column 3.
`"All the ‘Highest Number Previously Paid For? IN THISSPACE is less than 20. enter ‘20".
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`. “‘ It the'Highest Number Previousty Paid For' IN THIS SPACE is less than 3, enter ‘3'.
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`; Thefl-Ii-hest Number Previo
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`otal or Inde- ndent is the h- host number found in the a - -r0oriate box in column 1.
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`isootlection 01 information is required by. 37 CFR 1.16. The intermation is required to obtain or retain a benefit by the public which is to tile (and by the
`USPTO to process) an application. Confidentiafity is governed by 35 U.S.C. 122 and 37 CFR 1.14.'This collection is estimated to take 12 minutes to' couplets.
`including gathering. preparing, and submittingthe completed application torm to the USPTO. Time will vary depending upon the individual ase.‘Any mm
`on the amount at time you require to complete thistorm and/or suggestions for reducing this burden, should be sent to the Chief Infermation Otiioer, U.S. Patent
`and Trademark Otfioe. U.S._Department ol Comoros. P.O. Box 1450. Alexandria. VA 22313-1450. 00 NOT SEND FEES OR COMPLETED FORMS TO THIS
`ADDRESS. SEND To: Commissioner for Patents. P.O.' Box 1460, Alexandria, VA 22313-1450.
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`I001) need ass/Stance in completing the form. all warm TO-9199 and select option 2
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