Official Federal Forms > US Copyright Office
Form RE For Renewal Registration RE - Official Federal Forms
| Form RE For Renewal Registration Form. This is a national form and can be used in US Copyright Office . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
5 1 A B C Form RE For Renewal Registration · United States Copyright Office answer only the questions that apply to your claim. registration number effective date of renewal registration do not write above this line. if you need more space, use form re / con. mm dd yyyy title and original term information Title of work as first published or registered: if you need more space, use space b on form re/con If periodical, give: Volume: Alternative title: Number: Issue date: ISSN: if you need more space, use space b on form re/con If first published as a contribution to a periodical or other collective work, give title of larger work: if you need more space, use space b on form re/con If periodical, give: Volume: D Number: Issue date: ISSN: Has this work (or the work in which it was first published, if a contribution) ever been registered? Yes ò Give registration number: or ÿ No ò (Complete Form RE/Addendum.) Publication date: (mm/dd/yyyy ) E F G H or ÿ Registration date, if registered as unpublished work: (mm/dd/yyyy ) Year date(s) in copyright notice, if earlier than actual publication year date: 19 Original copyright claimant(s): ISBN: if you need more space, use space b on form re/con If the work was originally registered in Class Ai or Bi, was a U.S. edition registered? Yes ò Give registration number: or ÿ No ò If the original registration record was corrected or amplified by supplementary registration on Form CA, give the registration number and effective date of the supplementary registration: Number: Date: I 2 A work or material claimed and author information Copyright for the renewal term is claimed in: (Check only one.) ò the entire work. 2 ò a contribution first published in a periodical or other collective work. 3 ò revisions in previously published or registered work. Describe revisions: 4 ò separate element(s) of authorship in a larger work. Specify element(s): 1 5 or ÿ ò The renewal claim is based on the first publication of a work previously registered as an unpublished work under registration number: B The following author(s) contributed to the work or material claimed: Name: Date of death, if applicable: (mm/dd/yyyy ) This author created: Name: Date of death, if applicable: (mm/dd/yyyy ) This author created: Name: Date of death, if applicable: (mm/dd/yyyy ) This author created: if there are additional authors, use space d on form re/con. PRIVACY ACT ADVISORY STATEMENT Required by the Privacy Act of 1974 (P.L. 93-579) The authority for requesting this information is title 17 U.S.C. §409 and §410. Furnishing the requested information is voluntary. But if the information is not furnished, it may be necessary to delay or refuse registration and you may not be entitled to certain relief, remedies, and benefits provided in chapters 4 and 5 of title 17 U.S.C. The principal uses of the requested information are the establishment and maintenance of a public record and the examination of the application for compliance with the registration requirements of the copyright code. Other routine uses include public inspection and copying, preparation of public indexes, preparation of public catalogs of copyright registrations, and preparation of search reports upon request. NOTE: No other advisory statement will be given in connection with this application. Please keep this statement and refer to it if we communicate with you regarding this application. American LegalNet, Inc. www.FormsWorkFlow.com application received: correspondence: ò yes examined by: 3 A do not write above this line. if you need more space, use form re / con. funds received: renewal term ownership information Name the party or parties entitled by law to claim the renewal copyright on the last day of the original 28-year term of copyright. For each statutory claimant named, give the basis of the claim, and provide a current address. Read instructions. Name: Address: Name: Address: Name: Address: Name: Address: as the: or ÿ Year of death: if there are additional statutory claimants, use space e on form re/con. as the: or ÿ Year of death: as the: or ÿ Year of death: as the: or ÿ Year of death: B This application is submitted by or on behalf of the: ( Check only one.) ( Go on to section 4.) or ÿ ò Assignee/successor of the statutory claimant(s) named above. (Complete space C below.) ò Statutory claimant(s) named above. C assignee/successor by means of transfer Current address: 4 5 certification I, the undersigned, hereby certify that I am the statutory claimant, the assignee/successor, or the duly authorized agent of the statutory claimant or assignee/successor, and that the statements made by me in this application are correct. Typed or printed name: Handwritten signature: Date: payment, correspondence, and mailing information Deposit account number: Account name: Contact information for correspondence, including name and mailing address: Phone: ( ) Fax: ( ) Email: mailing address for certificate: name number/street apt/suite city/town state/province zip/postal code country 17 USC §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. form re rev: 02 / 2011 print: xx / xxxx -- xx,000 Printed on recycled paper u.s. government printing office: xxxx-xxx-xxx / xx,xxx American LegalNet, Inc. www.FormsWorkFlow.com 5 Instructions for Form RE Read these instructions before completing the application. Privacy Act Notice: Sections 408410 of title 17 of the United States Code authorize the Copyright Office to collect the personally identifying information requested on this form in order to process the application 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 USC section 705. It will appear in the Office's online catalog. If you do not provide the information requested, registration may be refused or delayed, and you may not be entitled to certain relief, remedies, and benefits under the copyright law. " Use this form for works published or registered from January 1, 1964, through December 31, 1977. " Do not use this form for works published or registered before January 1, 1964, or after December 31, 1977. See circular 15, Renewal of Copyright, and Code of Federal Regu
|
|||||||
