Micro Entity Registration Form

MICRO ENTITY REGISTRATION FORM

This Micro Entity Registration Form (the Form) is executed on Effective Date: by and between Registrant Name: of Registrant Address: ("Registrant") and Registrar Name: of Registrar Address: ("Registrar").

Recitals

WHEREAS: Registrant seeks recognition as a Micro Entity for the purposes of reduced fees and administrative treatment under applicable fee-schedule rules and institutional policies administered by Registrar;

WHEREAS: Registrar receives and records claims of Micro Entity status and processes fee reductions and related administrative changes upon satisfactory demonstration of eligibility;

WHEREAS: Registrant represents and warrants that the information provided in this Form is accurate, complete, and submitted in good faith and that Registrant understands the legal consequences of an intentional misrepresentation.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the parties agree as follows:

1. Definitions

For purposes of this Form, the following definitions apply unless the context otherwise requires:

1.1 "Micro Entity" means an entity that satisfies the eligibility criteria set forth in Section 2 and is accepted by Registrar for reduced fee treatment; "Registrant" means the party seeking Micro Entity status.

2. Eligibility and Certification

2.1 Representations. Registrant hereby represents and warrants under penalty of perjury that the statements checked and supplied in this Form are true and correct as of the Effective Date. Registrant further warrants that it meets all of the eligibility criteria required to qualify as a Micro Entity and will promptly notify Registrar if Registrant ceases to meet any criterion.

2.2 Entity Type (check applicable box(es) and complete identifying information):
Individual Corporation Limited Liability Company Partnership

2.3 Prior Filings and Assignments. Registrant certifies the following (mark all that apply and provide numeric details where requested):

Registrant and associated inventors have not been named as inventors on more than four previously filed patent applications

Registrant affirms that it has not assigned, granted, or conveyed an exclusionary license to a party whose gross status would disqualify Registrant from Micro Entity status

3. Financial Eligibility

3.1 Gross Income Certification. Registrant certifies, under penalty of perjury, that Registrant's gross household income for the calendar year preceding the Effective Date is less than the income threshold required for Micro Entity status. Registrant shall provide documentary evidence of income upon request of Registrar.

4. Representations, Warranties, and Remedies

4.1 Registrant represents and warrants to Registrar that all information provided herein is true and correct and that Registrant will maintain records substantiating the representations for a period of not less than five years. Registrant acknowledges that a material misrepresentation may result in loss of Micro Entity status, assessment of fees retroactively, and other remedies available at law or in equity.

4.2 Registrar may request additional documentation to verify eligibility. Registrar's acceptance of this Form and any grant of Micro Entity status is conditioned upon Registrar's review and approval of supporting materials.

5. Fees and Effect of Registration

5.1 Upon acceptance by Registrar, Registrant shall be eligible for fee reductions applicable to Micro Entity status as prescribed by Registrar's fee schedules. Such reductions apply only to fees expressly identified as reduced for Micro Entities and do not alter any substantive rights.

5.2 Registrant understands that fee reductions do not apply retroactively to fees already paid prior to Registrar's acceptance of this Form unless Registrar expressly so agrees in writing.

6. Notices

All notices required or permitted under this Form shall be in writing and delivered to the addresses set forth below. Notice is effective upon delivery by hand, or on the date of receipt if sent by certified mail, return receipt requested, or by nationally recognized overnight courier.

7. Amendments; Waiver; Counterparts

7.1 This Form may be amended only by a written instrument executed by both parties. No failure or delay by either party in exercising any right shall operate as a waiver. This Form may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

8. Governing Law; Entire Agreement; Severability

8.1 Governing Law. This Form shall be governed by and construed in accordance with the laws of the jurisdiction in which Registrar maintains its principal administrative office, without regard to conflicts of law rules.

8.2 Entire Agreement. This Form constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether written or oral.

8.3 Severability. If any provision of this Form is found to be invalid, illegal, or unenforceable, the remaining provisions shall remain in full force and effect and the parties shall endeavor to replace the invalid provision with a valid provision that achieves the original intent.

9. Certification

By checking the boxes below and signing this Form, Registrant certifies under penalty of perjury that the information provided is true and correct, that Registrant meets the eligibility requirements for Micro Entity status, and that Registrant understands the penalties for a knowing and willful false statement.

I certify that Registrant's gross household income for the preceding calendar year is below the required threshold for Micro Entity status. I certify that Registrant has not made assignments, grants, or conveyed rights that would disqualify Registrant from Micro Entity status. I certify that the information regarding prior patent applications provided above is true and complete to the best of my knowledge.

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