Application onDocket Number

PATENT APPLICATION FEE DETERMINATION RECORD

Effective October 1 , 2003

CLAIMS AS FILED - PART I

SMALL ENTITY OTHER THAN
TYPE OR SMALL ENTITY
TOTAL CLAIMS

FOR
s NUMBER FILED
.

NUMBER EXTRA
RATE
BASIC FEE
FEE
385.00
RATE
BASIC FEE
FEE
770.00
OR
TOTAL CHARGEABLE CLAIMS ^7 minus 20=
*
X$9= OR X$18=
INDEPENDENT CLAIMS ^ minus 3 =
*
X43= OR X86=
MULTIPLE DEPENDENT CLAIM PRESENT
+ 145= OR +290=
* If the difference in column 1 is less than zero, enter "0" in column 2
TOTAL |OR TOTAL
CLAIMS AS AMENDED - PART II OTHER THAN
(Column 1) (Column 2) (Column 3) SMALL ENTITY OR SMALL ENTITY
CLAIMS HIGHEST
ADDI- ADDI-
REMAINING NUMBER PRESENT DATC TIHMAI O ATr TION! Al
ENTA AFTER PREVIOUSLY EXTRA MAI t
AMENDMENT PAID FOR FEE FEE
MDM Total * Minus ** X$ 9= X$18=
OR
tME!
Independent * Minus
X43= OR X86=
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
+ 145= OR +290=
TOTAL TOTAL
ADDIT. FEE
OR ADDIT. FEE

(Column 1 (Column 2) (Column 3)

CLAIMS HIGHEST
REMAINING NUMBER ADDI- ADDI-
PRESENT
ENTB AFTER PREVIOUSLY EXTRA RATE TIONAL RATE TIONAL
AMENDMENT PAID FOR FEE FEE
Total * Minus 4*
MDM
X$ 9= OR X$18=
kMEl Independent Minus
X43= OR X86=
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
+145= OR +290=
*

TOTAL TOTAL
ADDIT. FEE
OR
(Column 1) (Column 2) (Column 3)
CLAIMS HIGHEST
O REMAINING NUMBER PRESENT ADDI- ADDI-
H AFTER PREVIOUSLY EXTRA RATE TIONAL RATE TIONAL
UJ AMENDMENT PAID FOR FEE FEE
MDM Total * Minus **
X$ 9= OR X$18=
lMEI Independent * Minus
X43= OR X86=
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
+145= OR +290=
* the entry in column 1 is less than the entry in column 2, write "0" in column 3.
If
TOTAL T0TAL
** If the "Highest Number Previously Paid For" IN THIS SPACE
is less than 20. enter
"20;""
ADDIT. FFF
OR
wn ADDIT. FEE
«**lf 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

FORMPTO-875 (Rev. 10/03) Patent and Trademark Office. U.S. DEPARTMENT OF COMMERCE