Continuation Sheet
for Application Forms
●
This Continuation Sheet is used in conjunction with Forms CA, PA, SE, SR, TX, and VA only.
Indicate which basic form you are continuing in the space in the upper right-hand corner.
●
Try to t the information called for into the spaces provided on the basic form.
●
If you do not have enough space on the basic form, use this Continuation Sheet, and submit
it with the basic form.
●
If you submit this Continuation Sheet, clip (do not tape or staple) it to the basic form and fold
the two together before submitting them.
●
Space A of this sheet is intended to identify the basic application.
Space B is a continuation of space 2 on the basic application.
Space C (on the reverse side of this sheet) is for the continuation of spaces 1, 4, or 6
on the basic application.
Privacy Act Notice: Sections 408-410 of title 17 of the United States Code authorize the Copyright Ofce 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 Ofce’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 benets under the copyright law.
DO NOT WRITE ABOVE THIS LINE. FOR COPYRIGHT OFFICE USE ONLY.
(Month) (Day) (Year)
CONTINUATION SHEET RECEIVED
EFFECTIVE DATE OF REGISTRATION
IDENTIFICATION OF CONTINUATION SHEET: This sheet is a continuation of the application for copyright registration
on the basic form submitted for the following work:
●
TITLE: Give the title as given under the heading “Title of this Work” in space 1 of the basic form.
Use the reverse side of this sheet if you need more space for continuation of spaces 1, 4, or 6 of the basic form.
NATURE OF AUTHORSHIP Briey describe nature of the material created by the author in which copyright is claimed. ▼
DATES OF BIRTH AND DEATH
Year Born▼ Year Died▼
NATURE OF AUTHORSHIP Briey describe nature of the material created by the author in which copyright is claimed. ▼
NAME OF AUTHOR ▼ DATES OF BIRTH AND DEATH
Year Born ▼ Year Died ▼
NATURE OF AUTHORSHIP Briey describe nature of the material created by the author in which copyright is claimed. ▼
NAME OF AUTHOR ▼ DATES OF BIRTH AND DEATH
Year Born ▼ Year Died ▼
Identication
of
Application
A
Continuation
of Space 2
B
d
e
f
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
●
NAME(S) AND ADDRESS(ES) OF COPYRIGHT CLAIMANT(S) : Give the name and address of at least one copyright claimant
as given in space 4 of the basic form.
NAME OF AUTHOR ▼
WAS THIS AUTHOR’S CONTRIBUTION
TO THE WORK
Anonymous? ❑ Yes ❑ No
Pseudonymous? ❑ Yes ❑ No
If the answer to either
of these questions is
“Yes,” see detailed
instructions.
Was this contribution to the
work a “work made for hire”?
AUTHOR’S NATIONALITY OR DOMICILE
Name of Country
❑ Yes
❑ No
Citizen of
Domiciled in
OR
{
▼
▼
WAS THIS AUTHOR’S CONTRIBUTION
TO THE WORK
Anonymous? ❑ Yes ❑ No
Pseudonymous? ❑ Yes ❑ No
If the answer to either
of these questions is
“Yes,” see detailed
instructions.
Was this contribution to the
work a “work made for hire”?
AUTHOR’S NATIONALITY OR DOMICILE
Name of Country
❑ Yes
❑ No
Citizen of
Domiciled in
OR
{
▼
▼
PA
PAU
SR
SRU
TX
TXU
VA
VAU
Page of pages
If the answer to either
of these questions is
“Yes,” see detailed
instructions.
WAS THIS AUTHOR’S CONTRIBUTION
TO THE WORK
Anonymous? ❑ Yes ❑ No
Pseudonymous? ❑ Yes ❑ No
Was this contribution to the
work a “work made for hire”?
AUTHOR’S NATIONALITY OR DOMICILE
Name of Country
❑ Yes
❑ No
Citizen of
Domiciled in
OR
{
▼
▼
Form ____
⁄
CON
3
UNITED STATES COPYRIGHT OFFICE
REGISTRATION NUMBER
