Form PTO/SB/65 Petition to Accept Unavoidably Delayed Payment of Mainte

PTO/SB/65 (03-09)
Approved for use through 03/31/2012. 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.

PETITION TO ACCEPT UNAVOIDABLY DELAYED PAYMENT OF
MAINTENANCE FEE IN AN EXPIRED PATENT (37 CFR 1.378(b))

Docket Number (Optional)

Mail to: Mail Stop Petition
Commissioner for Patents
P.O. Box 1450

Alexandria VA 22313-1450

Fax: (571) 273-8300

NOTE: If information or assistance is needed in completing this form, please contact Petitions Information at
(571) 272-3282.
Patent Number:

Application Number:

Issue Date:

Filing Date:

CAUTION: Maintenance fee (and surcharge, if any) payment must correctly identify: (1) the patent
number (or reissue patent number, if a reissue) and (2) the application number of the actual
U.S. application (or reissue application) leading to issuance of that patent to ensure the fee(s)
is/are associated with the correct patent. 37 CFR 1.366(c) and (d).
Also complete the following information, if applicable:
The above-identified patent:
is a reissue of original Patent No.

original issue date

original application number

,

original filing date

;

.

resulted from the entry into the U.S. under 35 U.S.C. 371 of international application
filed on

.

CERTIFICATE OF MAILING OR TRANSMISSION (37 CFR 1.8(a))
I hereby certify that this paper (along with any paper referred to as being attached or enclosed) is
(1) being deposited with the United States Postal Service on the date shown below with sufficient postage as first class
mail in an envelope addressed to Mail Stop Petition, Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313­
1450 OR
(2) transmitted by facsimile on the date shown below to the United States Patent and Trademark Office at (571) 273­
8300.

Date

Signature

Typed or printed name of person signing Certificate

[Page 1 of 4]
This collection of information is required by 37 CFR 1.378(b). 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 ADDRESS. SEND
TO: Mail Stop Petition, Commissioner for Patents, 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.

PTO/SB/65 (03-09)
Approved for use through 03/31/2012. 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.

1. S
MALL ENTITY
Patentee claims, or has previously claimed, small entity status. See 37 CFR 1.27
2. LOSS OF ENTITLEMENT TO SMALL ENTITY STATUS
Patentee is no longer entitled to small entity status. See 37 CFR 1.27(g)
3. MAINTENANCE FEE (37 CFR 1.20(e)-(g))
The appropriate maintenance fee must be submitted with this petition, unless it was paid earlier.
Small Entity

NOT Small Entity
Amount

Fee

(Code)

Amount

Fee

(Code)

$

3 ½ yr fee

(1551)

$

3 ½ yr fee

(2551)

$

7 ½ yr fee

(1552)

$

7 ½ yr fee

(2552)

$

11 ½ yr fee

(1553)

$

11 ½ yr fee

(2553)

MAINTENANCE FEE BEING SUBMITTED $
4. S
URCHARGE
The surcharge required by 37 CFR 1.20(i)(1) of $
(Fee Code 1557) must be paid as a
condition of accepting unavoidably delayed payment of the maintenance fee.
SURCHARGE FEE BEING SUBMITTED $

5. MANNER OF PAYMENT
Enclosed is a check for the sum of $
Please charge Deposit Account No.

the sum of $

.

Payment by credit card. Form PTO-2038 is attached.

6. AUTHORIZATION TO CHARGE ANY FEE DEFICIENCY
The Director is hereby authorized to charge any maintenance fee, surcharge or petition fee deficiency to
Deposit Account No.

.

[Page 2 of 4]

PTO/SB/65 (03-09)
Approved for use through 03/31/2012. 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.

7.

OVERPAYMENT
As to any overpayment made, please
Credit to Deposit Account No.
OR
Send refund check

WARNING:
Petitioner/applicant is cautioned to avoid submitting personal information in documents filed in a patent application that may
contribute to identity theft. Personal information such as social security numbers, bank account numbers, or credit card
numbers (other than a check or credit card authorization form PTO-2038 submitted for payment purposes) is never required by
the USPTO to support a petition or an application. If this type of personal information is included in documents submitted to the
USPTO, petitioners/applicants should consider redacting such personal information from the documents before submitting them
to the USPTO. Petitioner/applicant is advised that the record of a patent application is available to the public after publication of
the application (unless a non-publication request in compliance with 37 CFR 1.213(a) is made in the application) or issuance of
a patent. Furthermore, the record from an abandoned application may also be available to the public if the application is
referenced in a published application or an issued patent (see 37 CFR 1.14). Checks and credit card authorization forms PTO­
2038 submitted for payment purposes are not retained in the application file and therefore are not publicly available.

8.

SHOWING
The enclosed statement will show that the delay in timely payment of the maintenance fee was unavoidable
since reasonable care was taken to ensure that the maintenance fee would be paid timely and that this
petition is being filed promptly after the patentee was notified of, or otherwise became aware of, the
expiration of the patent. The statement must enumerate the steps taken to ensure timely payment of the
maintenance fee, the date and the manner in which the patentee became aware of the expiration of the
patent, and the steps taken to file the petition promptly.

9. PETITIONER(S) REQUESTS THAT THE DELAYED PAYMENT OF THE MAINTENANCE FEE BE ACCEPTED AND THE
PATENT REINSTATED.

Date

Signature(s) of Petitioner(s)

Typed or printed name(s)

Registration Number, if applicable

Address

Telephone Number

Address

ENCLOSURES:
Maintenance Fee Payment
Statement why maintenance fee was not paid timely
Surcharge under 37 CFR 1.20(i)(1) (fee for filing the maintenance fee petition)
Other:

[Page 3 of 4]

PTO/SB/65 (03-09)
Approved for use through 03/31/2012. 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.

37 CFR 1.378(d) states: “Any petition under this section must be signed by an attorney or agent
registered to practice before the Patent and Trademark Office, or by the patentee, the assignee, or
other party in interest.”

Signature

Date

Type or printed name

Registration Number, if applicable
STATEMENT

(In the space below, please provide the showing of unavoidable delay recited in paragraph 8 above.)

(Please attach additional sheets if additional space is needed)
[Page 4 of 4]

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.