Free Document Cover Sheet - Federal

File Size: 97.0 kB
Pages: 2
File Format: PDF
State: Federal
Category: Copyright
Author: United States Copyright Office
Word Count: 1,396 Words, 8,902 Characters
Page Size: Letter (8 1/2" x 11")

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6 DocumentCoverSheet BasicInformation
Read all of the instructions below before completing this form. Use of the Document Cover Sheet is optional but encouraged.

When to use this form Use the Document Cover Sheet when you are

submitting a document for recordation in the U. S. Copyright Office.

sheet and one copy of the cover sheet for each document that is being submitted for recordation. The two copies of the Document Cover Sheet, the document, and the fee must be sent together in the same envelope or package. The Copyright Office cannot process them unless they are received together. Send to: Library of Congress, Copyright Office, Documents Recordation Section, 101 Independence Avenue SE, Washington, DC 20559-6000 Cover sheets should be typed or printed and should contain the information requested so that the Copyright Office can process the document and return it. Be sure to complete space 8 so that the recorded document can be returned. The Copyright Office will process the document based on the information in the document or an attachment that is part of the document. Information for indexing will not be taken from the Document Cover Sheet or attachments that were not part of the document when it was executed (signed). To be recorded, the document must satisfy the recordation requirements of the copyright law and Copyright Office regulations.

Mailing requirements It is important to send the original cover

The person submitting a document with a cover sheet is solely responsible for verifying the correctness of the cover sheet and the sufficiency of the document. Recording a document submitted with or without a cover sheet does not constitute a determination by the Copyright Office of the document's validity or effect. Only a court may make such a determination. When a Document Cover Sheet is submitted, it will be imaged with the document as part of the public record.
privacy act advisory statement (Required by the Privacy Act of 1974 (P.L. 93-579)): The authority for requesting this information is title 17 USC, sec. 205. Furnishing the requested information is voluntary. But if the information is not provided, it may be necessary to delay recordation. The principal uses of the requested information are the establishment and maintenance of a public record and the evaluation for compliance with the recordation requirements of section 205 of the copyright code. Other routine uses include public inspection and copying, preparation of public indexes, preparation of public catalogs of copyright recordations, 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 cover sheet.

Space 1: First party given in the document This information is only

used to connect the Document Cover Sheet and the document if they become separated. No information is entered in the catalog record from this space.

deposit account number and name. The Office only accepts domestic money orders and checks payable through a U.S. bank with American Bankers Association routing numbers. International and postal money orders are not accepted.
Space 6: Completeness of document Check the appropriate box. Please read the "Important note"if checking "Record `as is.'"All documents recorded under 205 of the Copyright Act must be complete by their own terms to be recorded. Notices of termination recorded under 203, 304(c), and 304(d) must be complete and exact duplicates of the notices as served. Please refer to Copyright Office regulations in Chapter 37 CFR 201.4 and 201.10 and Circular 12, Recordation of Transfers and Other Documents, for more information. Space 7: Certification of photocopied documents Complete this

Space 2: First title given in the document This information is only

used to connect the Document Cover Sheet and the document if they become separated. No information is entered in the catalog record from this space.

titles (including a.k.a. and other variant titles of a work) determines the recordation fee. In the case of multiple title documents, titles that are repeated in documents are counted as a single title, except where the document lists different issues, volumes, episode numbers, etc. following each title. Each such entry is regarded as a separate title and will be indexed separately and counted separately when computing the fee for recording the document. The Copyright Office verifies title counts. a document containing one title. There is an additional charge for each group of up to 10 additional titles. "Alternative" titles, "formerlyknown-as" titles, and "also-known-as" titles are considered to be extra titles. Titles are counted by groups. If there are fewer than 10 titles in a group, the fee for a group still applies. Copyright Office fees are subject to change. For current fees, check the Copyright Office website at, write the Copyright Office, or call (202) 707-3000. Please remember that the fee is based on the number of titles in a document, not the number of works.
Space 5: Fee enclosed Check the appropriate box. If a Copyright Space 4: Amount of fee calculated There is a basic fee for recording

Space 3: Total number of titles in the document The total number of

section only if submitting a photocopied document in lieu of a document bearing the actual original signature. If a photocopy of the original signed document is submitted, it must be accompanied by a sworn certification. A sworn certification signed by at least one of the parties to the document or that party's authorized representative (who is identified as such at space 7) will satisfy that requirement. The date entered in the date field should be the date you sign the Document Cover Sheet. Copies of documents on file in a federal, state, or local government office must be accompanied by an original official certification.

Office deposit account is to be charged, give the Copyright Office

Space 8: Return to Give the name and address of the person to whom the recorded document should be returned. The Copyright Office does not maintain paper files of recorded documents. The documents are imaged and returned to the person or firm designated in this space. Please include telephone number, fax number, and email address in case we need to contact you.

CopyrightOfficefeesaresubjecttochange. ForcurrentfeeschecktheCopyrightOfficewebsiteat,writetotheCopyrightOffice, orcall(202)707-3000.


united states copyright office ForRecordationofDocuments
Volume Volume Document Document d


For best results, fill in the form on-screen and then print it.

Date of recordation m Funds received



do not write above this line see instructions on reverse To the Register of Copyrights: Please record the accompanying original document or properly certified copy thereof.

1 2 3 4 5

First party name given in the document First title given in the document Total number of titles in the document Amount of fee calculated Fee enclosed

( important: Please read instruction for this and other spaces.)

Check Money order Fee authorized to be charged to Copyright Office deposit account

Deposit account number Deposit account name


Completeness of document

Document is complete by its own terms

Document is not complete. Record "as is."

important note: A request to record a document "as is" under 37 CFR 201.4(c)(2) is an assertion that: (a) the attachment is completely unavailable for recordation; (b) the attachment is not essential to the identification of the subject matter of the document; and (c) it would be impossible or wholly impracticable to have the parties to the document sign or initial a deletion of the reference to the attachment. Certification of Photocopied Document Complete this certification if a photocopy of the original signed document is substituted for a document bearing the actual original signature. note: This space may not be used for documents that require an official certification. I declare under penalty of perjury that the accompanying document is a true and correct copy of the original document. Signature Duly authorized agent of Date



Return to:

Name Number / street City Phone number Email State Fax number Apt / suite Zip

send to: Library of Congress, Copyright Office, Documents Recordation Section, 101 Independence Avenue SE, Washington, DC 20559-6000 include all these together: (1) Two copies of this form; (2) payment from a deposit account or by check / money order payable to Register of Copyrights; and (3) your document.
form dcs rev: 09 / 2007 print: 09 / 2007 -- ,000 Printed on recycled paper U. S. Government Printing Office: 2007-330-945 / 60,