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MAINTENANCE FEE TRANSMITTAL FORM (USPTO)

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PTO/SB/45 (12-20)
Approved for use through 09/30/2021. OMB 0651-0016
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 EFS-Web)
Address to:
Mail Stop Maintenance Fee
Director of the United States
Patent and Trademark Office
P.O. Box 1450
Alexandria, VA 22313-1450
- OR –
Fax to: 571-273-6500
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 “Mail Stop Maintenance Fee, Director of
the United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450.”
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 PTO-2038 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]
C
olumn 2
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
Subtotals: Columns 3 & 4
_______ additional sheets attached for
l
isting additional patents.
Total Payment
* 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
for
m. Provide credit card information and authorization on Form PTO-2038.
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 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND
TO: Mail Stop Maintenance Fee, Director of the United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450.
If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.
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 record in this system of records may be disclosed, as a routine use, to a contractor of the Agency
having need for the information in order to perform a contract. Recipients of information shall be required
to comply with the requirements of the Privacy Act of 1974, as amended, pursuant to 5 U.S.C. 552a(m).
5. A record related to an International Application filed under the Patent Cooperation Treaty in this system
of records may be disclosed, as a routine use, to the International Bureau of the World Intellectual
Property Organization, pursuant to the Patent Cooperation Treaty.
6. A record in this system of records may be disclosed, as a routine use, to another federal agency for
purposes of National Security review (35 U.S.C. 181) and for review pursuant to the Atomic Energy Act
(42 U.S.C. 218(c)).
7. A record from this system of records may be disclosed, as a routine use, to the Administrator, General
Services, or his/her designee, during an inspection of records conducted by GSA as part of that agency’s
responsibility to recommend improvements in records management practices and programs, under
authority of 44 U.S.C. 2904 and 2906. Such disclosure shall be made in accordance with the GSA
regulations governing inspection of records for this purpose, and any other relevant (i.e., GSA or
Commerce) directive. Such disclosure shall not be used to make determinations about individuals.
8. A record from this system of records may be disclosed, as a routine use, to the public after either
publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent pursuant to 35 U.S.C.
151. Further, a record may be disclosed, subject to the limitations of 37 CFR 1.14, as a routine use, to
the public if the record was filed in an application which became abandoned or in which the proceedings
were terminated and which application is referenced by either a published application, an application
open to public inspection or an issued patent.
9. A record from this system of records may be disclosed, as a routine use, to a Federal, State, or local law
enforcement agency, if the USPTO becomes aware of a violation or potential violation of law or
regulation.
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MAINTENANCE FEE TRANSMITTAL FORM (USPTO)

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Completed 17 July 2021

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