Form PTO/SB/66 Petition to Accept Unintentionally Delayed Payment of Ma

PTO/SB/66 (04‐13) 
Approved for use through 05/31/2015. 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 UNINTENTIONALLY DELAYED PAYMENT OF 
MAINTENANCE FEE IN AN EXPIRED PATENT (37 CFR 1.378(c)) 

Docket Number (Optional)

Page 1 of 3 
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 the Office of Petitions at (571) 272‐3282. 
Patent No. _________________________________________ 

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 (37 CFR 1.8(a)) 
I hereby certify that this paper (* along with any paper referred to as being attached or enclosed) is being deposited with the United States 
Postal Service on the date shown below with sufficient postage as first class main in an envelope addressed to Mail Stop Petition, Commissioner 
for Patents, P.O. Box 1450, Alexandria, VA 22313‐1450, or facsimile transmitted to the U.S. Patent and Trademark Office on the date shown 
below. 
     ___________________________________ 
__________________________________________________________ 
                               Date                                                                                                                                               Signature 

__________________________________________________________ 
                                                                                                                                                  Typed or Printed Name of Person Signing Certificate 

[page 1 of 3] 
This collection of information is required by 37 CFR 1.378(c). 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 1 hour 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/66 (04‐13) 
Approved for use through 05/31/2015. 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 UNINTENTIONALLY DELAYED PAYMENT 
OF MAINTENANCE FEE IN AN EXPIRED PATENT (37 CFR 1.378(c)) 
Page 2 of 3 
1.  SMALL ENTITY 
          Patentee asserts, or has previously asserted, small entity status. See 37 CFR 1.27. 
2.  LOSS OF ENTITLEMENT TO SMALL ENTITY STATUS 
          Patentee is longer entitled to small entity status. See 37 CFR 1.27(g). 
3.  MICRO ENTITY 
          Patentee certifies, or has previously certified, micro entity status. See 37 CFR 1.29 
          Form PTO/SB/15A or B or equivalent must either be enclosed or have been submitted previously. 
4.  LOSS OF ENTITLEMENT TO MICRO ENTITY STATUS 
          Patentee is longer entitled to micro entity status. See 37 CFR 1.29(i). 
5.  MAINTENANCE FEE (37 CFR 1.20(e)‐(g)) 
          The appropriate maintenance fee must be submitted with this petition, unless it was paid earlier. 

Amount 

Undiscounted 
Fee 

(Code) 

Amount

Small Entity
Fee

(Code)

Amount 

Micro Entity 
Fee

(Code)

    $ ____________ 

3½ yr fee 

(1551) 

    $ ____________ 

3½ yr fee 

(2551) 

    $ ____________ 

3½ yr fee 

(3551) 

    $ ____________ 

7½ yr fee 

(1552) 

    $ ____________ 

7½ yr fee 

(2552) 

    $ ____________ 

7½ yr fee 

(3552) 

    $ ____________ 

11½ yr fee 

(1553) 

    $ ____________ 

11½ yr fee 

(2553) 

    $ ____________ 

11½ yr fee 

(3553) 

MAINTENANCE FEE BEING SUBMITTED $ ____________ 
6.  SURCHARGE 
The surcharge required by 37 CFR 1.20(i)(2) of: 
$ ____________ Undiscounted (Fee Code 1558); 
$ ____________ Small Entity (Fee Code 2558); or 
$ ____________ Micro Entity (Fee Code 3558), 
must be paid as a condition of accepting an unintentionally delayed payment of a maintenance fee. 
SURCHARGE FEE BEING SUBMITTED $ ____________ 
7.  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. 
          Payment made via EFS‐Web. 
8.  AUTHORIZATION TO CHARGE ANY FEE DEFICIENCY 
          The Director is hereby authorized to charge any maintenance fee, surcharge or petition deficiency to Deposit Account No. ____________ 

PTO/SB/66 (04‐13) 
Approved for use through 05/31/2015. 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 UNINTENTIONALLY DELAYED PAYMENT 
OF MAINTENANCE FEE IN AN EXPIRED PATENT (37 CFR 1.378(c)) 
Page 3 of 3 
9.  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. 
10.  STATEMENT 
The delay in payment of the maintenance fee for this patent was unintentional. 
11.  PETITIONER(S) REQUEST THAT THE DELAYED PAYMENT OF THE MAINTENANCE FEE BE ACCEPTED AND THE PATENT REINSTATED. 
     ___________________________________ 
__________________________________________________________ 
                                 Date                                                                                                                                    Signature(s) of Petitioner(s) 
     ___________________________________ 
__________________________________________________________ 
             Registration  Number,  if  applicable                                                                                                      Typed  or  Printed  Name(s) 
     ___________________________________ 
                        Telephone Number 
_____________________________________________________________________________________________________________________ 
Address 
_____________________________________________________________________________________________________________________ 
Address 
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.” 
12.  ENCLOSURES 
          Maintenance Fee Payment 
          Surcharge under 37 CFR 1.20(i)(2) (fee for filing the maintenance fee petition) 
          ________________________________________________________________________________________________________________ 
          ________________________________________________________________________________________________________________ 

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.