`'
`-
`' Effective January 1. 2003
`'
`
`
`
`
`Application or Docket. Number
`
`CLAIMS As FILED - FARTI‘
`Columnt ‘
` Column 2
`
`
`
`~ I
`
`
`
`
`
`
`
`'
`
`TOTAL
`OH ADDIT. FEE
`
`O
`
`CLAIMS
`;
`
`REMAINING
`NUMBER
`.
`
`
`1
`_
`.
`';
`PREVIOUSLY
`.
`AFTER
`; AMENDMENT ;-
`PA|DFOR
`'
`
`
`
`
`' --W_-
`
`
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
`
`
`[:1
`
`.
`
`ADD"
`TIONAL
`FEE
`
`RATE
`I
`
`ADD"
`TIONAL
`FEE
`
`oa-
`oa-
`«I
`
`TOTAL
`.
`OR ADDIT. FEE
`
`
`
`
`CLAIMS
`I
`HIGHEST
`
`REMAINING -
`NUMBER
`
`AFTER
`-
`.-
`~
`.
`PREVIOUSLY
`
`AMENDMENT
`,-
`PAIDFOR
`
`
`
`RATE
`
`ADDI-
`TIONAL
`
`FEE
`
`ADDI-
`TIONAL
`FEE
`
`FtATE
`
`.
`
`on
`
`on
`
`
`
`
`
`
`
`FORM PTO-875 (Rev. 12/02)
`Patent and Trademark Omce. U.S. DEPARTMENT OF COMMERCE
`
`romcmem cums
`
`MULTIPLE DEPENDENT CLAIM PRESENT
`
`D ‘
`
`
`
`
`
`
`
`~ SMALL ENTITY
`TYPE :3
`
`OTHER THAN
`OR SMALL ENTITY
`
`——
`mos 750.00
`
`'
`
`0R-
`
`
`
`
`
`
`"U
`
`-
`
`0R ‘TQTAL
`‘
`omen THAN
`.
`.
`SMALL ENTITY OR SMALL ENTITY
`ADDl-
`ADDI-
`TIONAL
`TIONAL
`FEE
`FEE
`
`'
`
`'
`
`RATE
`
`' If the difference in column 1 is less than zero. enter “0“ in column 2"
`.
`CLAIMS As AMENDED - PART II .
`.
`. Column 1 '
`.,
`-
`. Column 2
`
`
`.
`CLAIMS
`HIGHEST
`
`
`REMAINING
`-
`.
`j NUMBER
`RATE
`. AFTER
`- PREVIOUSLY
`
`
`
`AMENDMENT
`‘
`,
`PAID FOR
`on-
`
`or-
`on-
`
`
`
`
`on-EIIEI
`
`Ellg
`
`
`AMENDMENT8
`
`
`
`
`
`
`AMENDMENTC
`
`II
`--
`
`
`
`
`I ea
`
`
`
`' II the entry in column 1 is less than the entry in column 2. write '0' in column 3.
`'
`TOTAL
`ADDIT. FEE - OR Apogjggé
`“ II the ‘Highest Number Previously Paid For' IN THIS SPACE is less than 20. enter 'éol'
`"‘II the ‘Highest Number Previously Paid For“ IN THIS SPACE is less than 3. enter -‘3.'
`-
`.
`The ‘Highest Number Previously Paid For' (Total dr Independent) is the higheSt number lound in the appropriate box in column '1.
`
`
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