Application orDocket Number

PATENT APPLICATION FEE DETERMINATION RECORD

Effective October 1 , 2003 VP 7 z^^ V
CLAIMS AS FILED - PART I
SMALL ENTITY OTHER THAN
TYPE OR SMALL ENTITY
TOTAL CLAIMS RATc RATE FEE
FOR NUMBER FILED . NUMBE0.EXTRA BASIC FEE 385.00 OR BASIC FEE 770.00

TOTAL CHARGEABLE CLAIMS <2^^minus 20= •

)p XS9= ' OR XS18=
•k

INDEPENDENT CLAIMS minus 3 = X43= X86=

9 OR
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
SMALL ENTITY SMALL ENTITY
1 (Colunnn
CLAIMS
1) (Column 2)
HIGHEST
(Column 3) OR
ADDI- ADDI-
REMAINING NUMBER PRESENT
ENTA AFTER PREVIOUSLY EXTRA RATE TIONAL RATE TIONAL
AMENDMENT PAID FOR FEE FEE
o Total * Minus X$ 9= OR X$18=
z
Ui
Independent * Minus
X43= OR X86=
< FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
+ 145= OR +290=
TOTAL TOTAL
ADDIT. FFF OR
(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
o Total Minus ** X$9= OR X$18=
z
Ui
Ind pendent * Minus
< X43= OR X86=
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
+145= OR +290=
TOTAL
ADDIT FEE
OR
(Column 1) (Column 2) (Column 3)
CLAIMS HIGHEST
REMAINING NUMBER PRESENT ADDI- ADDI-
ENTC AFTER PREVIOUSLY EXTRA RATE TIONAL RATE TIONAL
AMENDMENT PAID FOR FEE FEE
MOM Total * Minus **
X$9= OR X$18=
^MEI
Independent * Minus
X43= OR X86=
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
+145= OR +290=
* Ifthe ntry in column 1 is less than the entry in column 2, «wite"0* in column 3.
TOTAL TOTAL
the -Highest Number PreviousJy Paid FoT IN THIS SPACE is less than 20, enter •20."
if OP
the "Highest Number Previously Paid For" IN THIS SPACE is less than 3, enter "S."
The "Highest Number Previously Paid For" (Total or Independent) is the highest number found in the appropriate box in column 1

FORMPTO«75 fRev..lCtf03) -Patent and TrademaMc Office. g.S. DEPARTMEhTT OF COMMERCE