`
`08/25/09
`
`PTO/SB/06 (12—04)
`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.
`Application or Docket Number
`PATENT APPLICATION FEE DETERMINATION RECORD
`Substitute for Form PTO—875
`
`‘
`
`'
`
`'
`
`12/547023
`
`'
`
`APPLICATION AS FILED — PART I
`(Column 1)
`
`(Column 2)
`
`SMALL ENTITY
`
`OTHER THAN
`SMALL ENTITY
`
`BASIC FEE
`
`SEARCH FEE
`
`EXAMINATION FEE
`
`(37 CFR 1.16(i))
`INDEPENDENT CLAIMS
`(37 CFR 1.16(h))
`
`APPLICATION SIZE
`FEE
`
`(37 CFR 1.16(s))
`
`NUMBER FILED
`
`If the specification and drawings exceed 100
`sheets of paper, the application size fee due is
`$270 ($135 for small entity) for each additional
`
`50 sheets or fraction thereof. See
`35 use. 41(a)(1)(G) and 37 CFR
`
`MULTIPLE DEPENDENT CLAIM PRESENT (37 CFR 1.160))
`
`" If the difference in column 1 is less than zero, enter "0" in column 2.
`
`APPLICATION AS AMENDED — PART II
`
`(Column 1)
`CLAIMS
`REMAINING
`AFTER
`AMENDMENT
`
`(Column 2)
`HIGHEST
`NUMBER
`PREVIOUSLY
`PAID FOR
`
`EXTRA
`
`(Column 3)
`
`PRESENT
`
`FEE (5)
`
`O30
`
`FEE (5)
`
`RATE (5)
`N/A
`
`N/A
`
`N/A
`
`RATE (S)
`NIA
`
`N/A
`
`2
`
`IA
`
`(0
`
`SMALL ENTITY
`ADDI-
`TIONAL
`FEE (3)
`
`RATE (5)
`
`TOTAL
`
`' OTHER THAN
`SMALL ENTITY
`
`ADDI-
`TIONAL
`FEE (S)
`
`RATE (3)
`
`'
`
`X
`
`II
`
`AMENDMENTA
`
`AMENDMENTB
`
`ADD'T FEE
`
`
`Total
`(37 CFR 1.16(i))
`Independent -
`(37 CFR 1.16(h))
`Application Size Fee (37 CFR 1.16(s))
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.16(i))
`
`(Column 1)
`CLAIMS
`REMAINING
`AFTER
`AMENDMENT
`
`(Column 2)
`HIGHEST
`NUMBER
`PREVIOUSLY
`PAID FOR
`
`
`
`Total
`(37 CFR 1.16(i))
`Independent
`(37 CFR 1.16(h))
`Application Size Fee (37 CFR 1.16(s))
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.160))
`
`Minus
`
`TOTAL
`ADD'T FEE
`
`NIA
`TOTAL
`AD D'T FEE
`
`(Column 3)
`
`PRESENT
`EXTRA
`
`RATE (5)
`
`ADDI-
`TIONAL
`FEE ($)
`
`RATE (5)
`
`ADDI-
`TIONAL
`FEE (s)
`
`TOTAL
`ADD'T FEE
`
`NIA
`TOTAL
`
`lfthe entry in column 1 is less than the entry in column 2, write "0" in column 3.
`'
`" lfthe "Highest Number Previously Paid For IN THIS SPACE is less than 20, enter '20'.
`"'
`lfthe "Highest Number Previously Paid Fof' IN THIS SPACE is less than 3, enter '3'.
`I he “Highest Number PreVIOUSIY Paid I'OF' (I Olal 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 lnforrnation 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, PO. Box 1450, Alexandria, VA 22313-1450.
`
`If you need assistance in completing the form, call 1-800-PTO—9199 and select option 2.
`
`
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