Date:
`
`04/09/10
`
`PTO/SB/OS (12-04)
`Approved for use through 7/31/2006. OMB 0651-0032
`US. 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 control number.
`PATENT APPLICATION FEE DETERMINATION RECORD
`Application or Docket Number
`
`
`
`Substitute for Form PTO-875
`
`1 2/757 1 08
`
`
`
`
`
`N/A
`N/A
`
`APPLICATION AS FILED — PART I
`(Column 1)
`(Column 2)
`I NUMBER EXTRA
`F0
`NUMBER FILED
`BASIC FEE
`(37 CFR 1.16(a), (b). or (c))
`N/A
`N/A
`SEARCH FEE
`(37 CFR 1.16(k), (i), or (m))
`EXAMINATION FEE
`(37 CFR 1.16(o). (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
`
`MULTIPLE DEPENDENT CLAIM PRESENT (37 CFR 1.160))
`
`N/A
`N/A
`
`N/A
`
`N/A
`N/A
`
`x$26
`x$110
`
`TOTAL
`
`SMALL ENTITY
`
`'
`OR
`
`OTHER THAN
`SMALL ENTITY
`
`RATE (3)
`
`FEE ($)
`
`RATE (3)
`
`FEE (3)
`
`N/A
`
`N/A
`N/A
`
`O ‘N
`
`.
`
`x$52
`x$220
`
`' If the difference in column 1 is less than zero, enter "0" in column 2.
`
`APP I ATI N A AMENDED — PART H
`L C
`O
`8
`(Column 1)
`CLAIMS
`REMAINING
`AFTER
`
`(Column 2)
`HIGHEST
`
`
`NUMBER
`PREVIOUSLY
`PAID FOR
`
`
`
`[—
`
`(Column 3)
`
`PRESENT
`EXTRA
`
`0R
`
`SMALL ENTITY
`ADDI-
`TIONAL
`FEE (S)
`
`RATE (5)
`
`-
`OR
`_ X
`
`390
`
`TOTAL
`
`OTHER THAN
`SMALL ENTITY
`ADDI-
`
`TIONAL I
`FEE (3)
`
`RATE ($)
`
`-
`- -
`
`
`
`
`<
`AMENDMENT
`0 a
`T I
`E
`I
`g (37CFR1‘160))
`2 Independent
`g (37 CFR 1.16(h))
`< Application Size Fee (37 CFR 116(5))
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.160))
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`OR
`— ——
`0R _
`TOTAL
`OR ADD'T FEE
`
`TOTAL
`ADD‘T FEE
`
`to
`
`
`
`
`
`
`
`
`
`
`
`(Column 2)
`(Column -1)
`'HIGHEST'
`CLAIMS
`
`
`NUMBER
`REMAINING
`AFTER
`PREVIOUSLY
`
`
`
`
`(Column 3)
`
`PRESENT
`EXTRA
`
`-
`
`OR
`
`RATE (5)
`
`ADDI-
`TIONAL
`FEE (S)
`
`RATE (3)
`
`_
`OR
`—— —
`N/A _ OR
`TOTAL
`ADD'T FEE
`
`TOTAL
`ADD‘T FEE
`
`OR
`
`' o (37 CFR1.16(i))
`5 Independent
`E (37 CFR1.16(h))
`< Application sue Fee <37 cm new»
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.160))
`
`
`
`
`
`ADDI-
`
`
`TIONAL
`FEE (S)
`
`
`
`
`
`
`
`lfthe 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 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 Information Officer, U.S. Paten'
`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, 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.
`
`