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PATENT APPLICATION FEE DETERMINATION RECORD 

Effective October 1 . 2003 



Application orDocket Number 



CLAIMS AS FILED -PART I 

(Column n (Column 2\ 



TOTAL CLAIMS 



FOR 



TOTAL CHARGEABLE CLAIMS 



INDEPENDENT CLAIMS 



NUMBER FILED 



minus 20= 



1 



minus 3 



NUMBER EXTRA 



MULTIPLE DEPENDENT CLAIM PRESENT 



If the difference in column 1 is less than zero, enter "0" in column 2 
CLAIMS AS AMENDED - PART II 







(Column 1) 




(iolumn 2) 


(Column 31 


IDMENTA | 




CLAIMS 
REMAINING 

AFTER 
AMENDMENT 




HIGHEST 
NUMBER 
PREVIOUSLY 
PAID FOR 


PRESENT 
EXTRA 


Total 


* 


Minus 


** 


= 


UJ 


Independent 


* 


Minus 


**# 


- 


< 


FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM 


n 






(Column 1 ) 




(Column 2) 


(Column 3) 


IDMENTB | 




CLAIMS 
REMAINING 

AFTER 
AMENDMENT 




HIGHEST 
NUMBER 
PREVIOUSLY 
PAID FOR 


PRESENT 
EXTRA 


Total 




Minus 


*-* 




UJ 

5 


Independent 


• 


Minus 


*** 




< 


FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM 


□ 



SMALL ENTIT Y 
TYPE I 1 



OTHER THAN 
OR SMALL ENTITY 



[ AMENDMENT C | 


\ 


\V>SWIU " f 

CLAIMS 
REMAINING 

AFTER 
AMENDMENT 




HIGHEST 
NUMBER 
PREVIOUSLY 
PAID FOR 


PRESENT 
EXTRA 


Total 


* 


Minus 


*-* 




Independent 


• 


Minus 






FIRST PRESE 


NTATION OF MULTIPLE DEPENDENT CLAIM |_J 



RATE 


FEE 




RATE 


FEE I 






On 


3ASIC FEE 


770.00 I 


XS9= 




OR 


XS18= 




X43= 




OR 


X86= 




.145= 


m 


OR 


±290= 




TOTAL 




5or 


TOTAL 








OTHER THAN I 


SMALL ENTITY 


OR 


SMALL Ef ~!TY j 


RATE 


ADDI- 
TIONAL 
FEE 




RATE ! 


ADDI- 1 
TIONAL 1 
FEE 1 


XS 9= 




OR 


XS18= 




X43= 




OR 


X86= 




+ 145= 




OR 


+290= 




TOTAL 
ADDIT FEE 




OR 


TOTAL 
ADO IT FEE 










RATE 


ADDI- 
TIONAL 
FEE 




RATE 


ADDI- I 
TIONAL j 
FEE 1 


XS9= 




OR 


XS18= 




X43= 




OR 


X86= 




+ 145= 




OR 


+290= 


• 1 


TOTAL 
ADDIT. FEE 




OR 


TOTA 
ADOIT FE 


L j 



• If me enuy in column 1 is less than ine entry in column 2. write '0" in column 3 
- If the -Highest Numoer Previously Paid For" IN THIS SPACE is less than 20. enter "20. 
—II th» '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 



RATE 


ADDI- 
TIONAL 
FEE 


XS9= 




X43= 




+ 145 = 




TOTAL 
ADDIT. FEE 





OR 

OR 

OR 
OR 



RATE 



X$18= 



X86= 



+290= 



TOTAL 
ADDIT. FEE 



ADDI- 
TIONAL I 
FEE 



found in tne appropriate oo* m column i 



PATENT APPLICATION SERIAL NO. 



U.S. DEPARTMENT OF COMMERCE 
PATENT AND TRADEMARK OFFICE 
FEE RECORD SHEET 



12/17/2003 FFMMEIA 000000% 10735324 

01 FCt2001 385.00 OP 



03/26/2004 FFAHAEIft 00000053 20077ft 10735324 
01 FC:2203 145.00 DA 



PTO-1556 
(5/87) 



•U.S. GMimwit Printing Offk»: 2002 - 489-267/69033