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PTO/SB/45 (0313) Approved for use through 07/31/2018. OMB 06510016 U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. MAINTENANCE FEE TRANSMITTAL FORM (Do not submit this form electronically via EFSWeb) Address to: Director of the United States Patent and Trademark Office Attn: Maintenance Fee 2051 Jamieson Avenue, Suite 300 Alexandria, VA 22314 OR Fax to: 5712736500 I hereby certify that this correspondence is being deposited with the United States Postal Service with sufficient postage as first class mail in an envelope addressed to "Director of the United States Patent and Trademark Office, Attn: Maintenance Fee, 2051 Jamieson Avenue, Suite 300, Alexandria, VA 22314" on ___________________________________________________________________________________ Signature _____________________________________________________________________________ Typed or printed name __________________________________________________________________ Enclosed herewith is the payment of the maintenance fee(s) for the listed patent(s). 1. A check for the amount of $ _______________ for the full payment of the maintenance fee(s) and any necessary surcharge is enclosed. 2. Payment by credit card. Form PTO2038 is enclosed. 3. The Director is hereby authorized to charge $ _______________ to cover the payment of the fee(s) indicated below to Deposit Account No. _______________. 4. The Director is hereby authorized to charge any deficiency in the payment of the required fee(s) or credit any overpayment to Deposit Account No. _______________. Item Patent Number* Column 1 U.S. Application Number* [e.g., 08/555,555] Column 2 Subtotals: Columns 3 & 4 Total Payment Maintenance Fee Amount (37 CFR 1.20(e)(g) Column 3 Surcharge Amount (37 CFR 1.20(h)) Column 4 Payment Year (select one below) Column 5 3.5 yrs 7.5 yrs 11.5 yrs 1 2 3 4 5 _______ additional sheets attached for listing additional patents. * Information required by 37 CFR 1.366(c) (columns 1 & 2). Information requested under 37 CFR 1.366(d) (columns 3, 4, & 5). WARNING: Information on this form may become public. Credit card information should not be included on this form. Provide credit card information and authorization on Form PTO2038. Respectfully submitted,** Customer's Signature _____________________________________ Customer's Name ________________________________________ Registration Number, if applicable: __________________________ Telephone: _____________________________________________ Fax: ___________________________________________________ Note: All correspondence will be forwarded to the "Fee Address" or to the "Correspondence Address" if no "Fee Address" has been provided. See 37 CFR 1.363. Payment of small entity fee is appropriate if small entity status still exists, see 37 CFR 1.27(g). To establish small entity status or to notify of a loss of entitlement to small entity status, a written assertion is required. See 37 CFR 1.27 and 1.33(b). Payment of micro entity fee is appropriate if patent owner certifies micro entity status. Form PTO/SB/15A or B or equivalent must either be enclosed or have been submitted previously. To notify of a loss of entitlement to micro entity status, a written assertion is required. See 37 CFR 1.29 and 1.33(b). ** WHERE MAINTENANCE FEE PAYMENTS ARE TO BE MADE BY AUTHORIZATION TO CHARGE A DEPOSIT ACCOUNT, BOTH THE NAME AND SIGNATURE OF AN AUTHORIZED USER ARE REQUIRED. This collection of information is required by 37 CFR 1.366. The information is required to obtain or retain a benefit by the public which is to file (and by the USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11, 1.14 and 41.6. This collection is estimated to take 5 minutes to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any comments on the amount of time you require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S. Patent and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 223131450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Director of the United States Patent and Trademark Office, Attn: Maintenance Fee, 2051 Jamieson Avenue, Suite 300, Alexandria, VA 22314. If you need assistance in completing the form, call 1800PTO9199 and select option 2. American LegalNet, Inc. www.FormsWorkFlow.com Privacy Act Statement The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with your submission of the attached form related to a patent application or patent. Accordingly, pursuant to the requirements of the Act, please be advised that: (1) the general authority for the collection of this information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary; and (3) the principal purpose for which the information is used by the U.S. Patent and Trademark Office is to process and/or examine your submission related to a patent application or patent. If you do not furnish the requested information, the U.S. Patent and Trademark Office may not be able to process and/or examine your submission, which may result in termination of proceedings or abandonment of the application or expiration of the patent. The information provided by you in this form will be subject to the following routine uses: 1. The information on this form will be treated confidentially to the extent allowed under the Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from this system of records may be disclosed to the Department of Justice to determine whether disclosure of these records is required by the Freedom of Information Act. 2. A record from this system of records may be disclosed, as a routine use, in the course of presenting evidence to a court, magistrate, or administrative tribunal, including disclosures to opposing counsel in the course of settlement negotiations. 3. A record in this system of records may be disclosed, as a routine use, to a Member of Congress submitting a request involving an individual, to whom the record pertains, when the individual has requested assistance from the Member with respect to the subject matter of the record. 4. A rec
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