5 FormRE registration number ForRenewalRegistration · UnitedStatesCopyrightOffice effective date of renewal registration answer only the questions that apply to your claim. do not write above this line. if you need more space, use form re / con. 1 A B C mm dd yyyy title and original term information Titleofworkasfirstpublishedorregistered: Ifperiodical,give: Volume: Alternativetitle: Number: Issuedate: if you need more space, use space b on form re/con ISSN: if you need more space, use space b on form re/con Iffirstpublishedasacontributiontoaperiodicalorothercollectivework,givetitleoflargerwork: if you need more space, use space b on form re/con Ifperiodical,give: Volume: D E f Number: Issuedate: ISSN: Hasthiswork(ortheworkinwhichitwasfirstpublished,ifacontribution)everbeenregistered? Yesò Give registration number: or ÿ Noò (Complete Form RE/Addendum.) Publicationdate: (mm/dd/yyyy ) or ÿ Registrationdate,ifregisteredasunpublishedwork: ISBN: (mm/dd/yyyy ) Yeardate(s)incopyrightnotice,ifearlierthanactualpublicationyeardate:19 Originalcopyrightclaimant(s): IftheworkwasoriginallyregisteredinClassAiorBi,wasaU.S.editionregistered? Yesò Give registration number: or ÿ Noò g h i if you need more space, use space b on form re/con 2 A IftheoriginalregistrationrecordwascorrectedoramplifiedbysupplementaryregistrationonFormCA,givetheregistration numberandeffectivedateofthesupplementaryregistration: Number: Date: work or material claimed and author information òtheentirework. 2 òacontributionfirstpublishedinaperiodicalorothercollectivework. 3 òrevisionsinpreviouslypublishedorregisteredwork.Describe revisions: 4 òseparateelement(s)ofauthorshipinalargerwork.Specify element(s): 1 Copyrightfortherenewaltermisclaimedin: (Check only one.) or ÿ 5 òTherenewalclaimisbasedonthefirstpublicationofaworkpreviously registeredasanunpublishedworkunderregistrationnumber: B Thefollowingauthor(s)contributedtotheworkormaterialclaimed: Name: Dateofdeath,ifapplicable: Name: Dateofdeath,ifapplicable: Name: Dateofdeath,ifapplicable: (mm/dd/yyyy ) (mm/dd/yyyy ) (mm/dd/yyyy ) Thisauthorcreated: Thisauthorcreated: Thisauthorcreated: 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: examined by: funds received: ò yes A 3 do not write above this line. if you need more space, use form re / con. renewal term ownership information Namethepartyorpartiesentitledbylawtoclaimtherenewalcopyrightonthelastdayoftheoriginal28-yeartermofcopyright. Foreachstatutoryclaimantnamed,givethebasisoftheclaim,andprovideacurrentaddress.Read instructions. Name: Address: Name: Address: Name: Address: Name: Address: asthe: or ÿ Yearofdeath: if there are additional statutory claimants, use space e on form re/con. asthe: or ÿ Yearofdeath: asthe: or ÿ Yearofdeath: asthe: or ÿ Yearofdeath: B Thisapplicationissubmittedbyoronbehalfofthe: (Check only one.) (Go on to section 4.) or ÿ ò Assignee/successorofthestatutoryclaimant(s)namedabove. (Complete space C below.) ò Statutoryclaimant(s)namedabove. C assignee/successor by means of transfer Currentaddress: 4 certification I,theundersigned,herebycertifythatIamthestatutoryclaimant,theassignee/successor,orthedulyauthorizedagentofthe statutoryclaimantorassignee/successor,andthatthestatementsmadebymeinthisapplicationarecorrect. Typedorprintedname: Date: 5 Handwrittensignature: payment, correspondence, and mailing information Depositaccountnumber: Accountname: Contactinformationforcorrespondence,includingnameandmailingaddress: Phone:( ) Fax:( ) Email: mailing address for certificate: name number/street city/town state/province zip/postal code apt/suite 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:04/2014 Printedonrecycledpaper u.s. government printing office:2014-xxx-xxx/xx,xxx American LegalNet, Inc. www.FormsWorkFlow.com  5 InstructionsforFormRE PrivacyActNotice:Sections408­410oftitle17oftheUnited States theapplicationforcopyrightregistration.Byprovidingthis Readtheseinstructionsbeforecompletingtheapplication. CodeauthorizetheCopyrightOfficetocollectthepersonally identifyinginformationrequestedonthisforminordertoprocess information,youareagreeingtoroutineusesoftheinformation thatincludepublicationtogivelegalnoticeofyourcopyrightclaim asrequiredby17USCsection705.ItwillappearintheOffice'sonline catalog.Ifyoudonotprovidetheinformationrequested,registration mayberefusedordelayed,andyoumaynotbeentitledtocertain relief,remedies,andbenefitsunderthecopyrightlaw. " UsethisformforworkspublishedorregisteredfromJanuary1,1964, throughDecember31,1977. " Donotusethisformforworkspublishedorregisteredbefore January1,1964,orafterDecember31,1977. Seecircular15,Renewal of Copyright,andCode of Federal Regulations (37CFR202.17),RegistrationofClaimstoCopyright­Renewals,for moredetailedinformation. AllCopyrightOfficeformsandcircularsareavailableat www.copyright.gov. howtocompletethisform Completetheformonyourpersonalcomputerandprintitout,or printoutablankformandcompleteitusingblackink. Leaveblankanyquestionthatdoesnotapplytoyourcopyright claim. UseContinuation Form RE/CONtoaddthenamesofauthorsor statutoryclaimantsiftherearemorethanfourorifyouneedadditionalspacefortitles. CompleteaForm RE/Addendumina