Author's Name

The individual(s) who actually created the work. Joint Authors can be listed if accurate. If the work is anonymous or pseudonymous indicate in Additional Comments section below

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Author’s Nationality or Domicile

Give the country of which the author is a citizen or the country in which the author is domiciled.

Email Address

Phone

Please enter Applicant's phone number

(###)

###

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Give the name(s) and address(es) of the copyright claimant(s) in this work even if the claimant is the same as the author. Copyright in a work belongs initially to the author of the work (including, in the case of a work made for hire, the employer or other person for whom the work was prepared). The copyright claimant is either the author of the work or a person or organization to whom the copyright initially belonging to the author has been transferred.

If the claimant is not the author, a brief statement explaining how the claimant obtained ownership of the copyright

For example by assignment. The statute provides that, if the copyright claimant is not the author, the application for registration must contain “a brief statement of how the claimant obtained ownership of the copyright.” If any copyright claimant named above is not an author named above, give a brief statement explaining how the claimant(s) obtained ownership of the copyright. Examples: “By written contract”; “Transfer of all rights by author”; “Assignment”; “By will.”

The author’s contribution to the work.

Examples: “Words”; “Coauthor of Music”; “Words and Music”

Type of Work

Literary Work

Work of the Visual Arts

Work of the Performing Arts

Sound Recording

Motion Picture/Audiovisual Work

Other

Provide the year in which the creation of this work was completed.

Insert "01" in month and date fields Under the statute, a work is “created” when it is fixed in a copy or phonorecord for the first time. Where a work has been prepared over a period of time, the part of the work existing in fixed form on a particular date constitutes the created work on that date. The date you give here should be the year in which the author completed the particular version for which registration is now being sought, even if other versions exist or if further changes or additions are planned.

YYYY

Date of First Publication

Provide the month, day, and year the work was first published in any country. If you do not know the exact date of first publication, give the approximate month, day, and year, which may be a later date than above. The statute defines “publication” as “the distribution of copies or phonorecords of a work to the public by sale or other transfer of ownership, or by rental, lease, or lending.” A work is also “published” if there has been an “offering to distribute copies or phonorecords to a group of persons for purposes of further distribution, public performance, or public display.” Give the full date (month, day, year) when, and the country where, publication first occurred. If first publication took place simultaneously in the United States and other countries, it is sufficient to state “U.S.A.” in Nation of Publication section below

YYYY

Nation of first publication, if the work has been published when the application is submitted

Nation of First Publication Insert the country where the work was first published. If the work was first published on the same day in the United States and another country, select “United States” as the Nation of First Publication. If the work was first published in two foreign countries on the same day, you may select either country as the Nation of First Publication.

Is the work is a work made for hire?

I.e., work prepared by an employee within scope of employment. If yes, please provide details in Additional Comments section below

Yes

Title of Work to be Registered

Please enter the Title of the Work to be registered - i.e. "Songs in the Key of Life", "Old Icelandic Farm Recipes" Every work submitted for copyright registra- tion must be given a title to identify that particular work. If the copies or phonorecords of the work bear a title or an identifying phrase that could serve as a title, transcribe that wording completely and exactly on the application. Indexing of the registration and future identification of the work will depend on the information you give here.

Describe any previous or additional titles of work

Complete this section if there are any additional titles for the work under which someone searching for the registration might be likely to look or under which a document pertaining to the work might be recorded.

Describe preexisting material contained in the work being submitted for registration, if any

Are there any prior copyright registrations for this work?

Please provide all application or registration numbers of other marks owned by Applicant, if any.

Upload a Copy of The Work to be Registered upload

NOTE: Please re-name all files to include Applicant's name before uploading to ensure your files are bundled correctly. Ex: JonesCookbook.pdf

ISSN, ISRC, ISMN, ISAN, ISWC, ISTC or EIDR Numbers

If your work has an ISSN, ISRC, ISMN, ISAN, ISWC, ISTC or EIDR number, give it in the space provided. Note: International Standard Book Numbers are assigned by the R. R. Bowker Company.

Additional Comments, if any

Please use this optional section if there is any additional information you want to share.

Credit Card Type

Please select credit card type

Visa

American Express

Mastercard

Discover

Credit Card Info

Click here if credit card name and billing address is the same as Applicant's name and address above. If not please enter below.

Click here if credit card name and billing address is the same as Applicant's name and address above.

Credit Card Name

First Name

Last Name

Credit Card Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Credit Card Number

Please enter credit card number

Expiration Date

Please enter credit card expiration date - **PLEASE ENTER "01" in the Day field

YYYY

Cvv code

Please enter the credit card's security code

Credit Card Authorization

By checking this box you authorize Robert S. Broder, PLLC to charge your credit card $645 for a single work copyright registration (including filing fee) and understand that there is no guaranty of registration.

Power of Attorney

By checking this box Applicant hereby appoints: Robert S. Broder, PLLC, 123 South Street, Oyster Bay, NY 11771 to prosecute this application to register, to transact all business in the United States Copyright Office in connection therewith.

Certification

By checking a box below you, being hereby warned that willful false statements and the like so made are punishable by fine or imprisonment, or both, and that such willful false statements may jeopardize the validity of the application or any resulting registration, declares that 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 and he/she is properly authorized to execute this application on behalf of the applicant; he/she believes the applicant to be the owner of the copyright sought to be registered.

author

other copyright claimant

owner of exclusive right(s)

Signature

Electronic Signature To electronically sign this document, enter any alpha/numeric characters (letters/numbers) of your choosing, preceded and followed by the forward slash (/) symbol. Most signatories enter their name between the two forward slashes; examples of acceptable "signatures" include: /john doe/; /jd/

Thank you for your Trademark Application.

If the mark is stylized or has has a graphic element or is a logo only mark and you did not attach to form please email it as a .jpeg attachment to broderlaw@gmail.com.

If use of the mark has begun and you did not attach to form, please email a specimen of use to broderlaw@gmail.com.

We will be in touch within 24-48 hours.

Copyright Application