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I Q’atn'cia (Boo/{er
`
`
`PATENT APPLICATION FEE DETERMINATION RECORD
`
`Effective December 8, 2004
`
`
`
`
`
`
`
`
`CLAIMS AS FILED - PART I
`
`(Column 1)
`
`(Column 2)
`
`Application or Docket Number
`
`SMALL ENTITY
`TYPE
`B OR
`
`OTHER THAN
`SMALL ENTITY
`
`
`
`
`
`RATE
`
`0R -E’[I1
`-cfi/fl
`m-
`--
`0R--
`0R--
`—OR-
`OR
`TOTAL ’m
`
`
`
`
`
`
`'OTHER THAN
`’
`
`
`OR L SMALL ENTITY
`
`'
`ADDI-
`
`
`TIONAL
`
`
`RATE
`
`OR x s 200 =
`
`TOTAL ADDIT‘
`FFF
`
`OR
`
`
`
`
`
`
`(Column 1)
`CLAIMS
`
`
`
`REMAINING
`
`
`~
`AFTER
`
`‘ AMENDMENT
`
`
`(Column 2)
`
`(Column 3)
`
`NUMBER
`
`
`
`PREVIOUSLY
`PAIDFOR
`
`
`
`PRESENT
`mm .
`
`
`
`
`
`
`
`
`
`
`
`
`INDEPENDENT CLAIMS
`, MULTIPLE DEPENDENT CLAIM PRESENT
`T‘
`If the difference in column 1 is less than zero, enter "0" in column 2
`
`minus 3 =-
`[j
`
`CLAIMS AS AMENDED - PART II
`(Column. 17)
`(Gown 2)
`'CLAIMS
`
`
`
`REMAINING
`NUMBER
`
`
`
`
`AFTER
`PREVIOUSLY
`
`
`
`AMENDMENT
`
`
`PAID FOR
`
`
`
`¥
`‘In I
`
`
`
`AMENDMENTA .4OiI :1 r:
`
`_Y
`
`(Column 3)
`
`SMALL ENTITY
`
`PRESENT
`EXTRA
`
`TIDDNDAL
`
`
`
`
`
`
`
`AMENDMENTB
` FFF
`
`lithe entry in column 1 Is less than the entry In column 2, write "0" In column 3.
`
`“ If the "nghest Number Previously Paid For" IN THIS SPACE ls less than '20'. enter "20".
`
`"‘ If the "Highest Number Previously Paid Fou" IN THIS SPACE ls 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.
`
`FORM PTO-875
`(Rev. 02f'2005)
`Patent and Trademark Office - US. DEPARTMENT OF COMMERCE
`
`

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