Copyright Royalty BoardAttn: Licensing DivisionPO Box 70977Washington, DC 20024-0977O037cial BusinessPenalty for Private Use $300.00Forwarding and return postage guaranteedþ 227 þ address correction requested 037036036035034035033032 031030027035026025027027037036035034033032 031034030034033031 027026025024023035022021034 026020020035027033024030033023022025023032021 027022033022025020025026022 037036 033034034037030026022þ (036037023020 017033023022 /024) American LegalNet, Inc. www.FormsWorkFlow.com How to File the Quarterly Statement of Account and Royalty FeeManufacturing or importing parties must 037le a separate quarterly statement of account for quarters 1, 2, and 3, corresponding to the calendar or 037scal year elected.036035034033032: þ Make sure that you are using the right form and read the instructions in the form. Collect all the necessary information.033031030027026025: þ Access 037ll-in statement of account form at http://www.copyright.gov/forms/formdart-q.pdf on a personal computer and print it out or hand print the information in dark ink. Give all the required information.032024035034025: þ Sign in space H. The statement of account is not acceptable unless it bears the original handwritten signature of an o036cer, principal, or agent authorized to certify it pursuant to the Audio Home Recording Act of 1992 (Chapter 10, Section 1003(c)(2) of title 17 USC).036027023034032024: þ Royalty fees must be paid by an electronic payment, pursuant to Section 201.28 (h)(1) of Title 37 , CFR. Make an electronic payment in the amount of the royalty fee due as calculated in space C. For detailed instructions, see circulars 74035 (on payments by wire), 74034 (on payments by Automated Clearing House credit), or 74033 (on payments using pay.gov), available at www.copyright.gov/circs/circ74 þ n .036035036032024: þ Send the completed statement of account to:Copyright Royalty Board Attn: Licensing Division PO Box 70977 Washington, DC 20024-0977033035022032024: Retain a copy of the entire statement, as 037led, in case it is needed for future reference.For Copyright O036ce regulations, forms, or additional information, visit www.copyright.gov or contact the Licensing Division between 8:30 035032 and 5:00 031032 eastern: (202) 707-8150 (phone); (202) 707-0905 (fax); or licensing@copyright.gov (email). American LegalNet, Inc. www.FormsWorkFlow.com 036035032035026016 017025033017032035026025: þ The statement of account must be 017led within 45 days after the close of the quarter covered by the statement.Instructions appear at the end of this form (pages i226iii).036037023 034037r021023035016f022 037036036035034025 030027025 037026032021Date received: þ Amount: þ Remittance number:030026035022025017 027022033022025027 034037r021023035016f022 037036036035034025Quarterly Statement of Account for Digital Audio Recording Products5 037036035034 033032035031 þ 030 þ 027Return to:Copyright Royalty Board Attn: Licensing Division PO Box 70977 Washington, DC 20024-0977026036025037024033023025031024032022 þ A þ 033034034037030026022035026016 r025023035037017 034037013025023025017 031021 022f035027 024030033023022025023032021 027022033022025020025026022 037036 033034034037030026022 þ 1 þ Check the applicable box. If your accounting period is the calendar year, enter the year; if it is a 037scal year, enter the 12-month period and years. þ Calendar year: þ January 1 through December 31, 20 þ / þ Fiscal year: þ beginning þ þ / , 20 þ / þ and ending þ / þ / , 20 þ / þ 2 þ Check the applicable box, and enter the three-month period and year(s) of the quarter for which this 037ling applies. þ Quarter 1 þ þ Quarter 2 þ þ Quarter 3 þ Beginning þ / þ / , 20 þ / þ and ending þ / þ / , 20 þ / þ B þ 026033020025, 033017017023025027027, 033026017 036035032035026016 027022033022030027Give the full legal name of the 223manufacturing or importing party224 and any other name used for the purpose of conducting the business of manufacturing and distributing or importing and distributing digital audio recording products. þ 1 þ Legal name þ þ 2 þ Mailing address þ þ þ Give other business name(s), if di030erent from line 1. þ 3 þ Business name þ þ þ 4 þ Check the applicable box to identify your 037ling status. þ Manufacturer þ þ Importer þ þ Manufacturer and importerPrivacy Act Notice: Chapter 10 of title 17, United States Code, authorizes the Copyright O037ce to collect the personally identifying information (PII) requested on this form in order to process your statement of account. PII is any personal information that can be used to identify or contact an individual, such as names, addresses, and telephone numbers. The Copyright O037ce collects this PII in order to identify the entities making the royalty fee payments. By providing your PII, you are agreeing to this routine use of it. The e036ects of not providing the PII requested are that it may delay processing of your statement of account, and it may a036ect the legal su037ciency of the 035ling, a determination that would be made by a court of law. þ Check here if this is the manufacturer's/importer's 037rst 037ling. If not, enter the ID number assigned by the Licensing Division þ / American LegalNet, Inc. www.FormsWorkFlow.com 025n033020r032025 Do not include the royalty fee from this example in your computations. þ C þ 034037020r030022033022035037026 037036 023037021033032022021 036025025026027032031: þ If you need more space, photocopy space C and attach the additional page(s) to the statement of account.030027021020023032017032035027026 027036 034027016017r032016 036031031: þ The formula to compute the royalty fee involves 14 components combined on pages 22263. There are two di030erent formulas for computing the royalty fee: (1) a formula for audio recording devices that are identi-037ed by the letters A, B, C, or D in column 4; and (2) a formula for audio recording media that are identi037ed by the letter E in column 4. For further explanation of the information required for each column, see pages i226ii of the instructions.030027021020023032035026f 032024031 034027016017r032016 036031031 036027034 025035f035032017r 017023025035027 034031030027034025035026f 025031013035030031033: þ On a line-by-line basis, enter the information in columns 12268, 10, and 12 and compute the royalty fee:Step 1: þ Multiply column 7 by column 8 and enter the result in column 9.Step 2: þ Multiply column 7 by column 12 and enter the result in column 13.Step 3: þ Multiply column 6 037rst by column 7, then by column 10, and enter the result in column 11.Step 4: þ Select the appropriate royalty fee from column 9, 11, or 13 as explained in the instructions, page ii, and enter that 037gure in column 14.030027021020023032035026f 032024031 034027016017r032016 036031031 036027034 025035f035032017r 017023025035027 034031030027034025035026f 021031025035023021: þ On a line-by-line basis, enter the information in columns 12267 and 10 and compute the royalty fee:Step 1: þ Multiply column 6 037rst by column 7, then by column 10.Step 2: þ Enter the result of Step 1 in column 14.030027021020023032035026f 032024031 032027032017r 034027016017r032016 036031031: Complete Lines 12267 on page 3.034027023026025035026f 027036036 025027rr017034033: You may not round o030 cents to whole dollars when calculating the royalty fee on a line-by-line basis in space C. However, you may round cents to whole dollars for the total fee due on line 7, space C.Line 1: þ Total column 14 and enter the 037gure here þ þ. .......................................................................................$ þ / Line 2: þ Reduction: þ Enter the amount from space D, page 3 þ þ. ....................................................................$ þ / Line 3: þ Credits: þ Enter the amount from space E, page 4 þ þ. ............................................................................$ þ / Line 4: þ Add lines 2 and 3 and enter total here þ þ. ................................................................................................ $ þ / þ þ þ þ þ þ þ þ þ þ þ 2 þ 267 þ 027026025032 024035025023022021 þ 026036025037024033023025031024032022 1 Product categories Portable persona