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Doc Code: MES.GIB
                                                                                  PTO/SB/15A (07-14)
Document Description: Certification of Micro Entity Status (Gross Income Basis)


                       CERTIFICATION OF MICRO ENTITY STATUS
                                     (GROSS INCOME BASIS)

Application Number or Control Number (if applicable):  Patent Number (if applicable):

First Named Inventor:                                  Title of Invention:

The applicant hereby certifies the following--

(1) SMALL ENTITY REQUIREMENT � The applicant qualifies as a small entity as defined in
    37 CFR 1.27.

(2) APPLICATION FILING LIMIT � Neither the applicant nor the inventor nor a joint inventor has
    been named as the inventor or a joint inventor on more than four previously filed U.S. patent
    applications, excluding provisional applications and international applications under the Patent
    Cooperation Treaty (PCT) for which the basic national fee under 37 CFR 1.492(a) was not paid,
    and also excluding patent applications for which the applicant has assigned all ownership rights,
    or is obligated to assign all ownership rights, as a result of the applicant's previous employment.

(3) GROSS INCOME LIMIT ON APPLICANTS AND INVENTORS � Neither the applicant nor the
    inventor nor a joint inventor, in the calendar year preceding the calendar year in which the
    applicable fee is being paid, had a gross income, as defined in section 61(a) of the Internal
    Revenue Code of 1986 (26 U.S.C. 61(a)), exceeding the "Maximum Qualifying Gross Income"
    reported on the USPTO Web site at http://www.uspto.gov/patents/law/micro_entity.jsp which is
    equal to three times the median household income for that preceding calendar year, as most
    recently reported by the Bureau of the Census.

(4) GROSS INCOME LIMIT ON PARTIES WITH AN "OWNERSHIP INTEREST" � Neither the
    applicant nor the inventor nor a joint inventor has assigned, granted, or conveyed, nor is under an
    obligation by contract or law to assign, grant, or convey, a license or other ownership interest in
    the application concerned to an entity that, in the calendar year preceding the calendar year in
    which the applicable fee is being paid, had a gross income, as defined in section 61(a) of the
    Internal Revenue Code of 1986, exceeding the "Maximum Qualifying Gross Income" reported on
    the USPTO Web site at http://www.uspto.gov/patents/law/micro_entity.jsp which is equal to three
    times the median household income for that preceding calendar year, as most recently reported
    by the Bureau of the Census.

                       SIGNATURE by an authorized party set forth in 37 CFR 1.33(b)

Signature

Name

Date                   Telephone                                                  Registration No.

           There is more than one inventor and I am one of the inventors who are jointly identified as the applicant. The required
           additional certification form(s) signed by the other joint inventor(s) are included with this form.
                                                 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. The United States Patent and
Trademark Office (USPTO) collects the information in this record under authority of 35 U.S.C. 2. The USPTO's
system of records is used to manage all applicant and owner information including name, citizenship, residence,
post office address, and other information with respect to inventors and their legal representatives pertaining to
the applicant's/owner's activities in connection with the invention for which a patent is sought or has been
granted. The applicable Privacy Act System of Records Notice for the information collected in this form is
COMMERCE/PAT-TM-7 Patent Application Files, available in the Federal Register at 78 FR 19243 (March 29,
2013), https://www.govinfo.gov/content/pkg/FR-2013-03-29/pdf/2013-07341.pdf.

Routine uses of the information in this record may include disclosure to: 1) law enforcement, in the event that
the system of records indicates a violation or potential violation of law; 2) a federal, state, local, or international
agency, in response to its request; 3) a contractor of the USPTO having need for the information in order to
perform a contract; 4) the Department of Justice for determination of whether the Freedom of Information Act
(FOIA) requires disclosure of the record; 5) a Member of Congress submitting a request involving an individual to
whom the record pertains, when the individual has requested the Member's assistance with respect to the
subject matter of the record; 6) a court, magistrate, or administrative tribunal, in the course of presenting
evidence, including disclosures to opposing counsel in the course of settlement negotiations; 7) the
Administrator, General Services Administration (GSA), or their designee, during an inspection of records
conducted by GSA under authority of 44 U.S.C. 2904 and 2906, in accordance with the GSA regulations and any
other relevant (i.e., GSA or Commerce) directive, where such disclosure shall not be used to make
determinations about individuals; 8) 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)); 9) the Office of Personnel
Management (OPM) for personnel research purposes; and 10) the Office of Management and Budget (OMB) for
legislative coordination and clearance.

If you do not furnish the information requested on this form, the USPTO may not be able to process and/or
examine your submission, which may result in termination of proceedings, abandonment of the application,
and/or expiration of the patent.
