Library of Congress Copyright Office Licensing Division 101 Independence Avenue SE Washington, DC 20557-6400 Official Business Penalty for Private Use $300 Forwarding Service Requested American LegalNet, Inc. www.FormsWorkFlow.com OFFICIAL BUSINESS UNITED STATES COPYRIGHT OFFICE STATEMENT OF ACCOUNT SA1-2 (SHORT FORM) IMPORTANT NOTICE ABOUT THIS STATEMENT OF ACCOUNT Statutory Changes Congress passed the STELA Reauthorization Act of 2014 ("STELARA"), and the President signed into law on December 4, 2014, as Public Law 113-200. Read the law at http://copyright.gov/legislation/pl113-200.pdf. For more information on this law (H.R. 5728), visit the FAQ page on the Copyright Office website at http://copyright.gov/licensing/stelara.html. Filing Fees: Effective January 1, 2014, pursuant to the Satellite Television Extension and Localism Act of 2010 (STELA), which granted authority to the Copyright Office to establish fees for the filing of statements of account (SOAs) under the section 111, 119, and 122 statutory licenses, the Office now assesses filing fees for all SOAs for current, past, and future accounting periods. For details, see the Federal Register, November 29, 2013 (78 fr 71498 http://www.copyright.gov/ fedreg/2013/78fr71498.pdf). Please be advised that the filing fee is deducted before the royalty payment is credited; thus the omission of the appropriate filing fee will result in an underpayment of royalty fees. Please remit the royalty fee and filing fee in one EFT payment. (SOA1 filing fee: $15; SOA2 filing fee: $20). Multicast versus Simulcast Multicast is a digital stream of programming that is transmitted by a television broadcast station and is not the station's primary stream. Simulcast is a multicast stream of a television broadcast station that duplicates the programming transmitted by the primary stream or another multicast stream of such station. Photocopy Required A legible copy of the semiannual statement of account must be submitted together with the original statement of account to the Copyright Office. Note: If replying to Licensing Division correspondence or if submitting revisions or amendments to your original SOA, please do not include extra photocopies of the SOA pages affected. Only one original version of revised SOA pages is required with your reply letter, together with a single copy of any Licensing Division correspondence. Fillable SOAs Available Online Access the fill-in statement of account form at www.copyright.gov/forms/sa1-2.pdf. Complete it on a personal computer and print it out. Or print out the form and complete it by hand in dark ink. Give all the required information. Electronic Payment of Royalty and Filing Fees Required Detailed instructions for making royalty payments via electronic funds transfer (EFT) are contained in circulars 74a, 74b, and 74c, which are available at www.copyright.gov/circs/circ74 or by contacting the Licensing Division (8:30 am and 5:00 pm eastern time) by phone at (202) 707-8150, fax at (202) 707-0905, or email at licfiscal@loc.gov. The remittance, which must include the appropriate filing fee, must be made payable to Register of Copyrights. If you are using Pay.gov, contact your bank to determine if your account will accept an Automated Clearing House (ACH) debit. Remittance Advice Required Federal regulations [37 C.F.R. sec. 201.17 (k)] require that a remittance advice be attached to statement(s) of account. A copy of the remittance advice must be sent by email or fax to the Licensing Division. The Office uses this remittance information to ensure the funds received by EFT are correctly allocated to each statement of account. Access a remittance advice form at www.copyright.gov/licensing/remittance-advice.pdf. Ceased Operations Procedures If your cable system completely shut down operations during the accounting period, report the facts as they existed on the last day of operations and submit the SOA with the associated royalty and filing fee payments and a cover letter informing the Licensing Division of ceased operations. If your cable system had no subscribers or gross receipts during the entire accounting period, do not submit the SOA or any fees. You do not need to notify us in this case. Important: Review Filings Please review all elements of your filing(s) before submitting them. Filing properly, including an accurate advice, facilitates processing of your statement(s) of account and payments, minimizes the need for us to contact you with questions, and reduces administrative and other costs. Library of Congress Copyright Office Licensing Division 101 Independence Avenue SE Washington, DC 20557-6400 Tel: (202) 707-8150 (8:30 am�5:00 pm, eastern time) Fax: (202) 707-0905 Email: licensing@loc.gov or Web: www.copyright.gov/licensing American LegalNet, Inc. www.FormsWorkFlow.com THIS FORM IS EFFECTIVE FOR ACCOUNTING PERIODS BEGINNING JANUARY 1, 2015 If you are filing for a prior accounting period, contact the Licensing Division for the correct form. SA1-2 Short Form Return to: Library of Congress Copyright Office Licensing Division 101 Independence Ave. SE Washington, DC 20557-6400 (202) 707-8150 For courier deliveries, see page ii of the general instructions. STATEMENT OF ACCOUNT for Secondary Transmissions by Cable Systems (Short Form ) General instructions are at the end of this form [pages (i) � (vii)]. FOR COPYRIGHT OFFICE USE ONLY DATE RECEIVED $ AMOUNT ALLOCATION NUMBER Accounting Period A ACCOUNTING PERIOD COVERED BY THIS STATEMENT: (Check one of the boxes and fill in the year date.) January 1�June 30 . . . . . . . . . . . . . . . (Year) July 1�December 31 . . . . . . . . . . . . . . . (Year) Owner B INSTRUCTIONS: Give the full legal name of the owner of the cable system in line 1. If the owner is a subsidiary of another corporation, give the full corporate title of the subsidiary, not that of the parent corporation. In line 2, list any other names under which the owner conducts the business of the cable system. If there were different owners during the accounting period, only the owner on the last day of the accounting period should submit a single statement of account and royalty fee payment covering the entire accounting period. Check here if this is the system's first filing. If not, enter the system's ID number assigned by the Licensing Division. __________ LEGAL NAME OF OWNER OF CABLE SYSTEM: BUSINESS NAME(S) OF OWNER OF CABLE SYSTEM (IF DIFFERENT): MAILING ADDRESS OF OWNER OF CABLE SYSTEM: