PTO/SB/06 (12-04)
`Approvedfor use through 7/31/2006. OMB 0651-0032
`U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
`Under the Paperwork Reduction Act of 1995, no personsare required to respond to a collection of information unless it disptays a valid OMB contro! number.
`PATENT APPLICATION FEE DETERMINATION RECORD
`Application or Docket Number
`Substitute for Form PTO-875
`1 1 /673 836
`
`APPLICATION AS FILED — PART!
`(Column 1)
`
`(Column 2)
`
`SMALL ENTITY
`
`OR
`
`eeeee
`er(37 CFR 1.16(a), (b), or (c))
`
`ferormisey|18nus
`INDEPENDENT CLAIMS
`
`
`(37 CFR 1.16(h))
`APPLICATION SIZE
`
`
`FEE
`
`
`
`
`(37 CFR 1.16(s))
`
`(37 CFR 1.16(k), (i), or (m))
`
`(37 CFR 1.16(0),
`TOTAL CLAIMS
`
`(p), or (q))
`
`:
`
`minus 3 =
`
`If the specification and drawings exceed 100
`sheets of paper, the application size fee due is
`
`$250 ($125 for small entity) for each additional
`
`50 sheetsorfraction thereof. See
`35 U.S.C. 41(a)(1)(G) and 37 CFR
`
`* If the difference in column 1 is less than zero, enter "0" in column2.
`
`REMAINING
`
`PRESENT
`
`OTHER THAN
`SMALL ENTITY
`
`RATE ($
`
`
`
`
`X$50
`
`X$200
`
`N/A
`
`TOTAL
`
`
`
`
`
`
`
`
`
` MULTIPLE DEPENDENT CLAIM PRESENT(37 CFR 1.16()))
`
`
`
`
`AM
`-
`!
`APPLICATION AS AMENDED-—PART| OTHER THAN
`
`
`(Column 1)
`(Column 2)
`(Column 3)
`SMALL ENTITY
`
`NUMBER
`
`
`PAID FOR
`5
`Ww
`Total
`=|(37 CFR 1.16())
`z|Independent
`= (37 CFR 1.16(h))
`
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.16())
`
`<|Application Size Fee (37 CFR 1.16(s)) |
`
`a
`5
`Total
`w
`B 1037 CFR 1.16()
`a Independent
`S|(37 CFR 1.16(h)) OR
`
`
`<<|Application Size Fee (37 CFR 1.16(s)) Ps Po
`
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENTCLAIM (37 CFR 1.16(j))
`OR
`N/A
`TOTAL
` ADD'T FEE
`
`(Column 1)
`CLAIMS
`REMAINING
`AFTER
`AMENDMENT
`
`(Column 2)
`HIGHEST
`NUMBER
`PREVIOUSLY
`PAID FOR
`
`(Column 3)
`
`PRESENT
`EXTRA
`
`
`
`
`RATE(8)
`
`TOTAL
`ADD'T FEE
`
`OR
`
`OR
`
`OR
`
`
`
`
`
`* If the entry in column1is fess than the entry in column 2, write “0” in column 3.
`
`**
`(f the “Highest Number Previously Paid For’ IN THIS SPACEisless than 20, enter “20°.
`*** {f the "Highest Number Previously Paid For’ IN THIS SPACEisless than3, enter “3”.
`The “Highest Number Previously Paid For” (Total or Independent) is the highest numberfound 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 istofile (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.Timewill vary depending uponthe individual case. Any comments
`on the amountof time you require to complete this form and/or suggestions for reducing this burden, should be sentto the ChiefInformation Officer, U.S. Patent
`and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMSTO THIS
`ADDRESS.
`SEND TO: Commissionerfor Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
`:
`
`if you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.
`
`TOTAL
`ADD'T FEE
`
`
`
`RATE(8)
`
`
`
`