COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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 call (202) 707-3000.Form CA 3 For Supplementary Registration UNITED STATES COPYRIGHT OFFICE:::::::Index No.REGISTRATION NUMBERCalendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)TXTXUPAPAUVAVAUSRSRUREEFFECTIVE DATE OF SUPPLEMENTARY REGISTRATIONMonthDayYearDO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.Title of Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Registration Number of the Basic Registration Year of Basic Registration ATHE PEOPLE OF THE STATE OF NEW YORK TOName(s) of Author(s) Name(s) of Copyright Claimant(s) Location and Nature of Incorrect Information in Basic Registration GREETINGS:Line Number Line Heading or Description Incorrect Information as It Appears in Basic Registration BWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofCorrected Information o'clock in the day ofnoon, and at any recessed in room, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of theExplanation of Correction Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Location and Nature of Information in Basic Registration to be Amplied Line Number Line Heading or Description Amplied Information and Explanation of Information C, one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:MORE ON BACK Complete all applicable spaces ((D-G) on the reverse side of this page. See detailed instructions.. Sign the form at Space F..American LegalNet, Inc. www.USCourtForms.compagesDO NOT WRITE HERE Page 1 ofCOURTFORM CA FORM CA RECEIVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.FUNDS RECEIVED DATECalendar No.JUDICIAL SUBPOENAEXAMINED BYPlaintiff(s) -against-Defendant(s)FOR COPYRIGHTOFFICEUSE ONLYCORRESPONDENCE REFERENCE TO THIS REGISTRATION ADDED TO BASIC REGISTRATION YES NODO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.Continuation of: Part B or Part CD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE STATE OF NEW YORKCOMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the located at,o'clock in the day ofnoon, and at any recessed on the, 20, at to testify and give evidence as a witness in this action on the part of theCorrespondence: Give name and address to which correspondence about this application should be sent.Efailure to comply with this subpoena is punishable as a contempt of court and will make you liable to behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a failure to comply.Phone () Fax () Email Deposit Account: If the registration fee is to be charged to a Deposit Account established in the Copyright Ofce, give name and number of Account. Name Account Number Certication* I, the undersigned, hereby certify that I am the: (Check only one)Honorable, one of the Justices of theday of, 20 County, author owner of exclusive right(s) other copyright claimant duly authorized agent of Name of author or other copyright claimant, or owner of exclusive right(s) F(Attorney must sign above and type name below)of the work identied in this application and that the statements made by me in this application are correct to the best of my knowledge.Typed or printed name Date Attorney(s) forHandwritten signature (X) Certicate will be mailed in windowenvelopeto this address:YOU MUST: Complete all necessary spaces Sign your application in Space FName Office and P.O. AddressNumber/Street/Apt 1. Application form 2. Nonrefundable ling fee in check or money order payable to Register of Copyrights Library of Congress Copyright Ofce 101 Independence Avenue, S.E. Washington, D.C. 20559-6000G SEND ALL ELEMENTS IN THE SAME PACKAGE:Fees are subject to change. For current fees, check the Copyright Office website at www.copyright.gov, write the Copyright Office, or call (202) 707-3000.MAIL TO:City/State/ZIP Telephone No.: Facsimile No.: E-Mail Address:*17 U.S.C. ยง 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 led in connection with the application, shall be ned not more than $2,500.Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comU.S. Government Printing Ofce: 2002-491-423/60,009Rev: July 200220,000 Web Rev: July 2002 Printed on recycled paper
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