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Short Form SE Form. This is a Official Federal Forms form and can be use in US Copyright Office.
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4 Instructions for Short Form SE Detach and read these instructions before completing this form. Make sure all applicable spaces have been ﬁlled in before you return this form. When to Use This Form: To use this form, all the following conditions must be met. If any one of the conditions does not apply, register online at www.copyright.gov. Incorrect use of this form will result in a delay in your registration. 1. The claim must be in a collective work. 2. The work must be essentially an all-new collective work or issue. 3. The author must be a citizen or domiciliary of the United States. 4. The work must be a work made for hire. 5. The author(s) and claimant(s) must be the same person(s) or organization(s). 6. The work must be first published in the United States. Deposit to Accompany Application: An application for registration of a copyright claim in a serial issue first published in the United States must be accompanied by a deposit consisting of two copies (or phonorecords) of the best edition. Fee: Send the filing fee for each issue to be registered. Do not send cash or currency. See Circular 4, Copyright Office Fees. Mailing Requirements: Mail everything (application form, copy or copies, and fee) in one package to: Library of Congress, Copyright Office-SE, 101 Independence Avenue SE, Washington DC 20559. Collective Work: The term “collective work” refers to a work, such as a serial issue, in which a number of contributions are assembled into a collective whole. A claim in the “collective work”extends to all copyrightable authorship created by employees of the author, as well as any independent contributions in which the claimant has acquired ownership of the copyright. Publication: 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.” Creation: A work is “created”when it is fixed in a copy (or phonorecord) for the first time. Work Made for Hire: A “work made for hire” is defined as: (1) a work prepared by an employee within the scope of his or her employment; or (2) a work specially ordered or commissioned for certain uses (including use as a contribution to a collective work), if the parties expressly agree in a written instrument signed by them that the work shall be considered a work made for hire. The employer is the author of a work made for hire. The Copyright Notice: Before March 1, 1989, the use of copyright notice was mandatory on all published works, and any work first published before that date should have carried a notice. For works first published on and after March 1, 1989, use of the copyright notice is optional. For more information about copyright notice, see Circular 3, Copyright Notice. For Further Information: To speak to a Copyright Office staff member, call (202) 707-3000 or 1-877-476-0778 from 8:30 am to 5:00 pm eastern time, Monday through Friday, except federal holidays. Recorded information is available 24 hours a day. Order forms and publications from Library of Congress, Copyright Office–COPUBS, 101 Independence Avenue SE, Washington, DC 20559 or call (202) 707-9100. Leave a recorded message. Download circulars and other information or register online on the Copyright Office website at www.copyright.gov. 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., secs. 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 law. 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. SPACE-BY-SPACE INSTRUCTIONS 1 SPACE 1: Title and Date of Publication Every work submitted for copyright registration must be given a title to identify that particular work. Give the complete title of the periodical, including the volume, number, issue date, or other indicia printed on the copies. If possible, give the International Standard Serial Number (ISSN). 2 SPACE 2: Author and Copyright Claimant Give the fullest form of the author and claimant’s name. If there are joint authors and owners, give the names of all the author/ owners. It is assumed that the authors and claimants are the same, that the work is made for hire, and that the claim is in the collective work. 3 SPACE 3: Date of Publication of This Particular Work Give the exact date on which publication of this issue first took place. The full date, including month, day, and year, must be given. Year in Which Creation of This Issue Was Completed: Give the year in which this serial issue was first fixed in a copy or phonorecord. If no year is given, it is assumed that the issue was created in the same year in which it was published. The date must be the same as, or no later than, the publication date. Certification: The application cannot be accepted unless it bears the handwritten signature of the copyright claimant or the duly authorized agent of the copyright claimant. Person to Contact for Correspondence About This Claim: Give the name, daytime phone and fax numbers, and email address (if available) of the person to whom any correspondence concerning this claim should be addressed. Give the address only if it is different from the address for mailing of the certificate. Deposit Account: Complete this space only if you currently maintain a deposit account in the Copyright Office. Otherwise, leave the space blank and forward the filing fee with your application and deposit. Mailing Address of Certificate: This address must be complete and legible because the certificate will be mailed in a window envelope. American LegalNet, Inc. www.FormsWorkFlow.com Copyright Office fees are subject to change. For current fees, check the Copyright Office website at www.copyright.gov, write the Copy ight Office, r or call (202) 707-3000 or 1-877-476-0778. 3 Short Form SE For a Serial UNITED STATES COPYRIGHT OFFICE REGISTRATION NUMBER 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. Effective Date of Registration Examined By Application Received Correspondence q Deposit Received One Two Fee Received DO NOT WRITE ABOVE THIS LINE. 1 TITLE OF THIS SERIAL AS IT APPEARS ON THE COPY Volume t Number t 2 Date on copies t ISSN t NAME AND ADDRESS OF THE AUTHOR AND COPYRIGHT CLAIMANT IN THIS COLLECTIVE WORK MADE FOR HIRE Year t Year in which creation of this issue was completed (if earlier than the year of publication): Year ▼ 3 DATE OF PUBLICATION OF THIS PARTICULAR ISSUE Month t Day t CERTIFICATION*: I, the undersigned, hereby certify that I am the copyright claimant or the authorized agent of the copyright claimant of the work identified in this application, that all the conditions specified in the instructions on the back of this form are met, that the statements made by me in this application are correct to the best of my knowledge. Handwritten signature ______________________________________________________________________________ Typed or printed name of signer ______________________________________________________________________ Account number Certificate will be mailed in window envelope to this address: Namet Number/Street/Apt t City/State/Zipt Email ▼ ▼ ▼ ▼ Name of account ▼ ▼ DEPOSIT ACCOUNT Name Address (if other than given below) Daytime phone ( ) Fax ( ) ▼ PERSON TO CONTACT FOR CORRESPONDENCE ABOUT THIS CLAIM YOU MUST: • Complete all necessary spaces • Sign your application 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-SE 101 Independence Avenue SE Washington, DC 20559 *17 U.S.C. §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 SE-Short Reviewed: 08 / 2012 Printed on recycled paper U.S. Government Printing Office: 2012-xxx-xxx/xx,xxx American LegalNet, Inc. www.FormsWorkFlow.com