Copyright Application Form

Copyright Application

  • 1 WORK BEING REGISTERED
  • 1c. * For a serial issue
  • Publication (If this work has not been published, skip to section 2)
  • 1j. If line 1i above names a serial issue
  • 1k. If work was preregistered
  • 2 AUTHOR INFORMATION [* Complete either 2a or 2b]
  • 2a. Personal name
  • Continuation of Author Information
  • 3 COPYRIGHT CLAIMANT INFORMATION
  • Claimant [* complete either 3a or 3b - If you do not know the address for a claimant, enter "not known" in the Street address and City fields.]
  • 3a. Personal name
  • (Add "+" and country code for foreign numbers)
  • 4 LIMITATION OF COPYRIGHT CLAIM [Skip section 4 if this work is all new.]
  • 4b. Previous registration(s)
  • 5 RIGHTS AND PERMISSIONS CONTACT
    Check if information below should be copied from the first copyright claimant
  • Personal name
  • (Add "+" and country code for foreign numbers)
  • (Add "+" and country code for foreign numbers)
  • 7 MAIL CERTIFICATE TO: * Complete either 7a, 7b, or both
  • 8 CERTIFICATION 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 filed in connection with the application, shall be fined not more than $2,500. I certify that I am the author, copyright claimant, or owner of exclusive rights, or the authorized agent of the author, copyright claimant, or owner of exclusive rights, of this work, and that the information given in this application is correct to the best of my knowledge.
  • 8a. Handwritten signature _______________________
  • 8e. Applicant's internal tracking number (optional)
  • Winter LLP Todd Winter, Esq.