Form VA For A Work Of The Visual Arts {VA} | Pdf Fpdf Doc Docx | Official Federal Forms
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Form VA For A Work Of The Visual Arts {VA} | Pdf Fpdf Doc Docx | Official Federal Forms

Form VA For A Work Of The Visual Arts {VA}

This is a Cooley IP Forms form that can be used for US Copyright Office.

Alternate TextLast updated: 9/10/2012

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Copyright Office 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. Privacy Act Notice: Sections 408-410 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 U.S.C. §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. 3 Form VA REGISTRATIONNUMBER For a Work of the Visual Arts UNITEDSTATESCOPYRIGHTOFFICE VA VAU EFFECTIVE DATE OF REGISTRATION Month Day Year 1 DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. TITLE OF THIS WORk NATURE OF THIS WORk See instructions PREVIOUS OR ALTERNATIVE TITLES 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 Work If published in a periodical or serial give: Volume Number Issue Date On Pages Under the law, the "author" of a "work made for hire" is generally the employer, not the employee (see instructions). 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 "Author" of that part, and leave the space for dates of birth and death blank. NOTE 2 a NAME OF AUTHOR DATES OF BIRTH AND DEATH Year Born Year Died AUTHOR'S NATIONALITY OR DOMICILE Name of Country WAS THIS CONTRIBUTION TO THE WORk A "WORk MADE FOR HIRE"? Yes No OR { Citizen of Domiciled in WAS THIS AUTHOR'S CONTRIBUTION TO THE WORk If the answer to either Anonymous? Yes No of these questions Pseudonymous? Yes No is "Yes," see detailed instructions. NATURE OF AUTHORSHIP Check appropriate box(es). See instructions 3-Dimensional sculpture 2-Dimensional artwork Reproduction of work of art NAME OF AUTHOR Map Photograph Jewelry design Technical drawing Text Architectural work DATES OF BIRTH AND DEATH Year Born b Year Died WAS THIS CONTRIBUTION TO THE WORk A "WORk MADE FOR HIRE"? Yes AUTHOR'S NATIONALITY OR DOMICILE Name of Country No OR { Citizen of Domiciled in WAS THIS AUTHOR'S CONTRIBUTION TO THE WORk If the answer to either Anonymous? Yes No of these questions Pseudonymous? Yes No is "Yes," see detailed instructions. NATURE OF AUTHORSHIP Check appropriate box(es). See instructions DO NOT WRITE HERE OFFICE USE ONLY 3 4 3-Dimensional sculpture 2-Dimensional artwork Reproduction of work of art Map Photograph Jewelry design Technical drawing Text Architectural work Month Nation Day Year a Year COPYRIGHT CLAIMANT(S) Name and address must be given even if the claimant is the same as the author given in space 2. APPLICATION RECEIVED ONE DEPOSIT RECEIVED TWO DEPOSITS RECEIVED FUNDS RECEIVED See instructions before completing this space. 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. MORE ON BACK · Complete all applicable spaces (numbers 5-9) on the reverse side of this page. · See detailed instructions. · Sign the form at line 8. American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of DO NOT WRITE HERE pages YEAR IN WHICH CREATION OF THIS WORk WAS COMPLETED This information must be given in all cases. b DATE AND NATION OF FIRST PUBLICATION OF THIS PARTICULAR WORk Complete this information ONLY if this work has been published. EXAMINED BY CHECKED BY FORM VA CORRESPONDENCE Yes FOR COPYRIGHT OFFICE USE ONLY DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. PREVIOUS REGISTRATION Has registration for this work, or for an earlier version of this work, already been made in the Copyright Office? Yes No If your answer is "Yes," why is another registration being sought? (Check appropriate box.) a. This is the first published edition of a work previously registered in unpublished form. b. This is the first application submitted by this author as copyright claimant. c. This is a changed version of the work, as shown by space 6 on this application. If your answer is "Yes," give: Previous Registration Number Year of Registration 5 a b a b See instructions before completing this space. DERIVATIVE WORk OR COMPILATION Complete both space 6a and 6b for a derivative work; complete only 6b for a compilation. a. Preexisting Material Identify any preexisting work or works that this work is based on or incorporates. 6 7 b. 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. DEPOSIT ACCOUNT If the registration fee is to be charged to a Deposit Account established in the Copyright Office, give name and number of Account. Name Account Number CORRESPONDENCE Give name and address to which correspondence about this application should be sent. Name/Address/Apt/City/State/Zip Area code and daytime telephone number Email ( ) Fax number ( ) CERTIFICATION* I, the undersigned, hereby certify that I am the check only one { author other copyright claimant owner of exclusive right(s) authorized agent of Name of author or other copyright claimant, or owner of exclusive right(s) 8 9 of the work identified 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 and date If this application gives a date of publication in space 3, do not sign and submit it before that date. Date Handwritten signature (X) X Certificate will be mailed in window envelope to this address: Name 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 filing fee in check or money order payable to Register of Copyrights 3. Deposit material MAIL TO: Library of Congress Copyright Office-VA 101 Independence Avenue SE Washington, DC 20559 Number/Street/Apt City/State/Zip *17 U.S.C. §506(e): Any person who knowingly makes a fa

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