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Form TX

Copyright Office Form TX 2012
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
76 views

Form TX

Copyright Office Form TX 2012
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

3

DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.
1
4
TITLE OF THIS WORK W
PREVIOUS OR ALTERNATIVE TITLES W
PUBLICATION AS A CONTRIBUTION If this work was published as a contribution to a periodical, serial, or collection, give information about the
collective work in which the contribution appeared. Title of Collective WorkW
If published in a periodical or serial give: Volume W Number W Issue Date W On Pages W
2
YEAR IN WHICH CREATION OF THIS
WORK WAS COMPLETED This information
must be given
in all cases.
DATE AND NATION OF FIRST PUBLICATION OF THIS PARTICULAR WORK
Complete this information
ONLY if this work
has been published.
COPYRIGHT CLAIMANT(S) Name and address must be given even if the claimant is the same as
the author given in space 2. W
TRANSFER If the claimant(s) named here in space 4 is (are) different from the author(s) named in
space 2, give a brief statement of how the claimant(s) obtained ownership of the copyright.W
Year
b a
Month Day Year
Nation
MORE ON BACK
DO NOT WRITE HERE
Page 1 of pages
Complete all applicable spaces (numbers 5-9) on the reverse side of this page.
See detailed instructions. Sign the form at line 8.
D
O

N
O
T

W
R
I
T
E

H
E
R
E
O
F
F
I
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E

U
S
E

O
N
L
Y
See instructions
before completing
this space.
NAME OF AUTHOR W DATES OF BIRTH AND DEATH
Year Born W Year Died W
NOTE
Under the law,
the author of
a work made
for hire is
generally the
employer, not
the employee
(see instruc -
tions). For any
part of this
work that was
made for hire
check Yes in
the space
provided, give
the employer
(or other
person for
whom the work
was prepared)
as Authorof
that part, and
leave the
space for dates
of birth and
death blank.
Name of Country
Citizen of
Domiciled in
{
Was this contribution to the work a
work made for hire?
OR
TYes
TNo
AUTHORS NATIONALITY OR DOMICILE WAS THIS AUTHORS CONTRIBUTION TO
THE WORK
Anonymous? T Yes T No
Pseudonymous? T Yes T No
If the answer to either
of these questions is
Yes, see detailed
instructions.
NATURE OF AUTHORSHIP %ULH\GHVFULEHQDWXUHRIPDWHULDOFUHDWHGE\WKLVDXWKRULQZKLFKFRS\ULJKWLVFODLPHGW
a
NAME OF AUTHOR W DATES OF BIRTH AND DEATH
Year Born W Year Died W
Name of Country
Citizen of
Domiciled in
{
Was this contribution to the work a
work made for hire?
OR
TYes
TNo
AUTHORS NATIONALITY OR DOMICILE WAS THIS AUTHORS CONTRIBUTION TO
THE WORK
Anonymous? TYes T No
Pseudonymous? TYes T No
If the answer to either
of these questions is
Yes, see detailed
instructions.
NATURE OF AUTHORSHIP %ULH\GHVFULEHQDWXUHRIPDWHULDOFUHDWHGE\WKLVDXWKRULQZKLFKFRS\ULJKWLVFODLPHGW
b
NAME OF AUTHOR W DATES OF BIRTH AND DEATH
Year Born W Year Died W
Name of Country
Citizen of
Domiciled in
{
Was this contribution to the work a
work made for hire?
OR
TYes
TNo
AUTHOR'S NATIONALITY OR DOMICILE WAS THIS AUTHORS CONTRIBUTION TO
THE WORK
Anonymous? TYes T No
Pseudonymous? TYes T No
If the answer to either
of these questions is
Yes, see detailed
instructions.
NATURE OF AUTHORSHIP %ULH\GHVFULEHQDWXUHRIPDWHULDOFUHDWHGE\WKLVDXWKRULQZKLFKFRS\ULJKWLVFODLPHGW
c
APPLICATION RECEIVED
ONE DEPOSIT RECEIVED
TWO DEPOSITS RECEIVED
FUNDS RECEIVED
Form TX
3 For a Nondramatic Literary Work
UNITED STATES COPYRIGHT OFFICE
REGISTRATION NUMBER
TX TXU
EFFECTIVE DATE OF REGISTRATION
Month Day Year
W
Copyright Ofce fees are subject to change.
For current fees, check the Copyright Ofce
website at www.copyright.gov, write the Copy-
right Ofce, or caII (202) 707-3000.
Privacy Act Notice: Sections 408-410 of titIe 17 of the United States
Code authorize the Copyright Ofce to coIIect the personaIIy identifying
information requested on this form in order to process the applica-
tion for copyright registration. By providing this information you are
agreeing to routine uses of the information that include publication
to give legal notice of your copyright claim as required by 17 U.S.C.
705. It wiII appear in the Ofces onIine cataIog. If you do not provide
the information requested, registration may be refused or delayed,
and you may not be entitIed to certain reIief, remedies, and benets
under the copyright law.
DEPOSIT ACCOUNT,IWKHUHJLVWUDWLRQIHHLVWREHFKDUJHGWRDGHSRVLWDFFRXQWHVWDEOLVKHGLQWKH&RS\ULJKW2IFHJLYHQDPHDQGQXPEHURIDFFRXQW
Name W Account Number W
CORRESPONDENCE Give name and address to which correspondence about this application should be sent. Name/Address/Apt/City/State/Zip W
RIWKHZRUNLGHQWLHGLQWKLVDSSOLFDWLRQDQGWKDWWKHVWDWHPHQWVPDGH
by me in this application are correct to the best of my knowledge.
Typed or printed name and date W If this application gives a date of publication in space 3, do not sign and submit it before that date.



Area code and daytime telephone number

W

( ) Fax number

W
( )

Email

W

T author
T other copyright claimant
T owner of exclusive right(s)
T authorized agent of
Name of author or other copyright claimant, or owner of exclusive right(s) V
9

Date

W
DERIVATIVE WORK OR COMPILATION
Preexisting Material Identify any preexisting work or works that this work is based on or incorporates. W
Material Added to This Work Give a brief, general statement of the material that has been added to this work and in which copyright is claimed.W
5
6
EXAMINED BY
CHECKED BY
CORRESPONDENCE
Yes
FORM TX
FOR
COPYRIGHT
OFFICE
USE
ONLY
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.
PREVIOUS REGISTRATION+DVUHJLVWUDWLRQIRUWKLVZRUNRUIRUDQHDUOLHUYHUVLRQRIWKLVZRUNDOUHDG\EHHQPDGHLQWKH&RS\ULJKW2IFH"
TYes TNo If your answer is Yes, why is another registration being sought? (Check appropriate box.)W
a.T7KLVLVWKHUVWSXEOLVKHGHGLWLRQRIDZRUNSUHYLRXVO\UHJLVWHUHGLQXQSXEOLVKHGIRUP
b. T7KLVLVWKHUVWDSSOLFDWLRQVXEPLWWHGE\WKLVDXWKRUDVFRS\ULJKWFODLPDQW
c.TThis is a changed version of the work, as shown by space 6 on this application.
If your answer is Yes, give: Previous Registration Number

W

Year of Registration

W
NameW
Number/Street/AptW
City/State/ZipW
*17 U.S.C. 506(e): Any person who knowingly makes a false representation of a material fact in the application for copyright registration provided for by section 409, or in any written statement fled in connection
with the application, shall be fned not more than $2,500.
See instructions
before completing
this space.
Handwritten signature W
7
8
CERTIFICATION* I, the undersigned, hereby certify that I am the
{
YOU MUST:
Complete all necessary spaces
Sign your application in space 8
SEND ALL 3 ELEMENTS
IN THE SAME PACKAGE:
1. Application form
2. Nonrefundable fling fee in check or money
order payable to Register of Copyrights
3. Deposit material
MAIL TO:
Library of Congress
Copyright Offce-TX
101 Independence Avenue SE
Washington, DC 20559
a
b
Check only one

W

a
b
Certicate
will be
mailed in
window
envelope
to this
address:
Form TX - Full Reviewed: 07/2012 Printed on recycled paper U.S. Government Printing Offce: 2012-xxx-xxx/xx,xxx

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