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
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Docket Number (Optional)
PETITION TO ACCEPT UNINTENTIONALLY DELAYED PAYMENT OF
MAINTENANCE FEE IN AN EXPIRED PATENT (37 CFR 1.378(b))
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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 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
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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.