Form Pto/sb/16 2007 - Provisional Application For Patent Cover Sheet

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Doc Code:

PTO/SB/16 (10-07)

Approved for use through 06/30/2010. OMB 0651-0032

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.

PROVISIONAL APPLICATION FOR PATENT COVER SHEET – Page 1 of 2

This is a request for filing a PROVISIONAL APPLICATION FOR PATENT under 37 CFR 1.53(c).

Express Mail Label No.

INVENTOR(S

)

Given Name (first and middle [if any])

Family Name or Surname

Residence

(City and either State or Foreign Country

)

Additional inventors are being named on the ________________________separately numbered sheets attached hereto

TITLE OF THE INVENTION (500 characters max):

Direct all correspondence to:

CORRESPONDENCE ADDRESS

The address corresponding to Customer Number:

Firm or

Individual Name

Address

City

State

Zip

Country

Telephone

ENCLOSED APPLICATION PARTS (check all that apply

)

Application Data Sheet. See 37 CFR 1.76

CD(s), Number of CDs

Drawing(s)

Number of Sheets __________________

Other (specify ______________________________

)

Specification (e.g. description of the invention) Number of Pages

__________________

Fees Due:

Filing Fee of $210 ($105 for small entity

If the specification and draw ngs exceed 100 sheets of paper, an application size fee is

also due, which is $260 ($130 for small entity for each additional 50 sheets or fraction thereof. See 35 U.S.C. 41(a)(1)(G) and 37 CFR 1.16(s).

)

METHOD OF PAYMENT OF THE FILING FEE AND APPLICATION SIZE FEE FOR THIS PROVISIONAL APPLICATION FOR PATENT

Applicant claims small entity status. See 37 CFR 1.27.

A check or money order is enclosed to cover the filing fee and application size fee (if applicable).

Payment by credit card. Form PTO-2038 is attached

TOTAL FEE AMOUNT

($)

The Director is hereby authorized to charge the filing fee and application size fee (if applicable) or credit any overpayment to Deposit

Account Number:

______________________.

A duplicative copy of this form is enclosed for fee processing.

USE ONLY FOR FILING A PROVISIONAL APPLICATION FOR PATENT

This collection of information is required by 37 CFR 1.51. 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 and 1.14. This collection is estimated to take 8 hours 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

SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450

ADDRESS.

If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.