Date:
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`02119110
`
`PTO/SB/06 (12-04)
`Approved for 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 persons are required to respond to a collection of information unless it displays a valid OMB~oontrol number.
`PATENT APPLICATION FEE DETERMINATION RECORD
`Application or Docket Number
`
`
`
`Substitute for Form PTO—875
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`
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`1 2/70 8 91 5
`
`APPLICATION AS FILED — PART I
`(Column 1)
`
`(Column 2)
`
`SMALL ENTITY
`
`OR
`
`OTHER THAN
`SMALL ENTITY
`
`
`
`(37 CFR 1.16(0). (p), or (q))
`TOTAL CLAIMS
`
`(37 CFR 1.16(i))
`
`INDEPENDENT CLAIMS
`
`(37 CFR 1.16(h))
`
`
`If the specification and drawings exceed 100
`APPLICATION SIZE
`
`sheets of paper. the application size fee due is
`
`
`FEE
`$260 ($130 for small entity) for each additional
`
`
`
`50 sheets or fraction thereof. See
`(37 CFR 1.16(s))
`
`
`
`35 U.S.C. 41(a)(1)(G) and 37 CFR
`390 MULTIPLE DEPENDENT CLAIM PRESENT (32 CFR 1.160))
`TOTAL
`TOTAL
`‘ If the difference in column 1 is less than zero, enter "0" in column 2.
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`AMENDMENTA
`
`
`
`(Column 3)
`
`APPLICATION AS AMENDED — PART II
`(Column 1)
`(Column 2)
`CLAIMS
`HIGHEST
`REMAINING
`NUMBER
`
`PAID FOR
`PREVIOUSLY
`
`PRESENT
`EXTRA
`
`AFTER- AMENDMENT
`
`Total
`--
`Independent
`--
`Application Size Fee (37 CFR 1.16(s))
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.160))
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`
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`BASIC FEE
`(37 CFR 1.16(a). (b), or (c))
`SEARCH FEE
`(37 CFR 1.16(k). (i), or (m))
`
`N/A
`
`N/A
`
`N/A
`
`N/A
`
`N/A
`
`N/A
`
`N/A
`
`N/A
`
`IEminus 3 =
`
`X$110
`
`OR
`
`SMALL ENTITY
`ADDI-
`TIONAL
`FEE (3)
`
`RATE (5)
`
`0 EU
`
`OR
`
`OR
`
`OTHER THAN
`SMALL ENTITY
`
`RATE (5)
`
`ADDI—
`TIONAL
`FEE (S)
`
`
`
`N/A
`TOTAL
`ADD'T FEE
`
`OR
`
`N/A
`—I3>r-
`0R ADD‘T FEE
`
`RATE (5)
`
`:EENG';
`
`RATE (3)
`
`0R
`
`OR
`
`ADDL
`:EENG:
`
`(Column 1)
`
`(Column 2)
`
`(Column 3)
`
`REMAINING
`CLAIMS
`AFTER
`AMENDMENT
`
`NUMBER
`HIGHEST
`PREVIOUSLY
`PAID FOR
`
`PRESENT
`EXTRA
`
`.
`m
`'5
`Total
`g
`o (37 CFR 1.16(i))
`E Independent
`5 (37 CFR 1.16(h))
`< Applicatlm Size Fee (37 CFR 146(5))
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.160))
`
`0R
`— ——
`oR —
`R
`TOTAL
`ADD'T FEE
`
`TOTAL
`ADD'T FEE
`
`o
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`'
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`If the entry in column 1 is less than the entry in column 2. write ‘0' in column 3.
`'
`" If the 'Highest Number Previously Paid For' IN THIS SPACE is less than 20, enter '20'.
`"'
`If the 'Highest Number Previously Paid For' IN THIS SPACE is 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.
`
`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 IJSPTO. 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 Information Officer, U.S. Pam
`and Trademark Office, U.S. 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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