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PATENT APPLICATION FEE DETERMINATION RECORD 

Effective October 1 , 2003 

CLAIMS AS FILED - PART I 

(Column 1) rcolumn?* 




Application orDocket Number 



TOTALCLAIMS 



FOR 



TOTAL CHARGEABLE CLAIMS 



INDEPENDENT CLAIMS 



NUMBER FILED 



inus 20= 



MULTIPLE DEPENDENT CLAIM PRESENT 



\ minus 3 = 



NUMBER EXTRA 



□ 



* If the difference in column , is less than zero, enter -<r in column 2 



SMALL ENTITY. OTHER THAN 

l — 1 OR SMALL ENTITY 



Total 



Independent 



.LAIMS AS AMENDED - PART II 

" J£olumnji) (Column 2] 

claims I — i :™^~™?^-L. 

REMAINING 
_ AFTER 
AMENDMENT 



. RATE 


FEE 


BASIC FEE 


385.00 


XS 9= 




X43= 


1 


♦ 145= 


• ( 


TOTAL 





OR BASIC FEE 



RATE 



XS18= 



X86= 



+290= 



FEE 



I OR TOTAL 




Minus 



Minus 



HIGHEST 
NUMBER 
PREVIOUSLY 
PAID FOR 



(Column 3) 



PRESENT 
EXTRA 



FIRST PRESENTATION Of= ~MULTIPLE DEPENDENT " CLAIM Q 



OTHER THAN 
SMALL ENTITY OR SMALL ENTITY 



'0 



Total 



Indepef 'enl 



{Column 1) 



Minus 



Minus 



higkeV r 
NUMr;i- q 
PRevio^3LV 
paid r- c >\ 



H': n 2) (Column 3) 



RATE 


ADDI- 
TIONAL 
FEE 




RATE 


ADDI- 
TIONAL 
"PEG , 


9= 




OR 


X$1B= 




■ X4J= 




OR 


X86= 




+ 145 = 




OR 


+290= 




TOTAL 
ADD IT. FEE 




np » TOTAL 
wn ADOIT. FEE 





PRESENT 
EXTRA 



TotaJ 



Independent 



Ft£MAIN;?vG 
AFTEH 
AMEND-vt-rr 



Minus 



Minus 



.JColyrpri 

highSt 

NUMB^t 
PREVIOUSLY 

paio ro a > 



(Column 3) 



RATE 


ADDI- 
TIONAL 
FEE 




RATE 


ADDI- 1 

tionalI 








_X$18= 




■ ~ x^r* 




OR 


X86= 




+145= 




OR 


+290x 


1 


TOTAL 
ADOIT. FEE 






TOTAL 





present 

EXTRA, 



^SL^^^^^ y^^E^wix^r^J^ — j =j 



If the entry in column 1 K i*«l<; - 

-If the -Hisl.asi Number ptS Fw* m ™! f^ ACE B ! " f$ ,han »• ««« 

™* -Hig.- :. Number P, ^l- ^-.^ ™' S SPACE fc ' » 3. "He, 



■'a* For" (T«al or InrJep^ndc 



RATE 


ADDI- 
TIONAL 
FEE 




RATE 


ADDI- J 
TIONALI 
—FEE J 


X$9= 




OR 


X$1B= 




X43= 




OR 


X86= 




♦ 145= 




OR 


♦290* 




1UIALI 
ADDIT. fTF I 


OR, 


TOTAL 
tDDiT.FEE 





* lound in Rr> P ropria1fl bos in column" i. 
Pa,0nl a * V Officers. OEPARTTOEKt Qf COMWEflcJ 1 



M3ENFJWUCAHQN FEE DETERttHAJtCH RECORD 

r*2G0t - 



MAIMS AS FILED "MAT I 




"8551 



irtttO 



tfUCRHS 



if fte Atoms tottfem t iafos»tfunitat««ftMorttafcm* 
_ _ ClAlAAS AS AMENDED - PART U 









■WW 


COTM 

























MAUCMfTTV 


OA 


small omnr 




















• * • 


was. 




OK 






xtoo» 




OR 










OH 






DOTAL 




0* TOTAL 






OH 


OTHER TtU0 

shall omnr 


RAJS 


TlOMAL 




RMS 


ADO*- 
TXONAL 


x»a» 




OR 






XI CO. 




OR 










OR 




















CU1UI 






cm* 








- -5*3 


• — > 






H VHH f MCI! 


-Iff 









RMC 






RATt 


AOOt- 
HON* 


XS2S> 




OR 






moo* 




OR 










OR 







4