Fillable Formdcs Form DCS (Document Cover Sheet)

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Formdcs Form DCS (Document Cover Sheet)

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Read all of the instructions below before completing this form.
When to use this form
Use Form DCS to submit a document that
is a transfer of copyright ownership or other document pertaining
to a copyright that you wish to have recorded under section 205 of
the Copyright Act. Use of Form DCS is mandatory, and a properly
completed Form DCS must accompany all documents submitted
to the Copyright Office for recordation under 17 U.S.C. § 205. A
properly completed Form DCS must also be used to submit a doc-
ument for recordation pertaining to a mask work under 37 C.F.R.
§ 211.2, a vessel design under 37 C.F.R. § 212.6, or a U.S. sound re-
cording fixed before February 15, 1972 under 37 C.F.R. § 201.35.
When not to use this form
Do not use Form DCS when submit-
ting any other type of document to the Office, such as notices of
termination, DMCA online service provider agent designations,
identification of anonymous/pseudonymous authors, author
death statements, visual arts registry statements, shareware regis-
try statements, or any Licensing Division documents.
How to use this form
Follow these instructions to complete
Form DCS. All fields are required to the extent applicable, and all
information should be typed or printed. Include one completed
and signed Form DCS for each document being submitted for
recordation. The Office may reject any document submitted for
recordation that is not accompanied by Form DCS or is accom-
panied by an incomplete or improperly prepared Form DCS.
Submission requirements
Submit together in the same envelope
or package: (1) a properly prepared Form DCS; (2) the document
to be recorded; (3) the proper filing fee; and (4) any additional
material being provided in connection with your submission,
such as an electronic title list, English translation of non-English
material, written justification for certain redacted material, or an
additional copy of this completed form and a self-addressed post-
age-paid envelope for a return receipt. Absent special arrange-
ment with the Office, the Office reserves the right to not process
your submission unless all of the items necessary for processing
are received together. Mail your submission to:
Library of Congress
Copyright Office–DOC, LM 433
101 Independence Avenue SE
Washington, DC 20559-6000
Electronic title lists
In addition to identifying the works to which
a document pertains in the paper submission, an electronic title
list may also be submitted. An electronic title list is an Excel file
containing certain indexing information about the relevant works,
such as their titles, types of work, registration numbers, and au-
thorship information. Submitting an electronic title list is optional,
but can significantly shorten the Office’s processing time for re-
cording a document. Consequently, the Office offers a reduced
filing fee for submissions that include them. For more informa-
tion about electronic title lists, including the requirements and
instructions for completing and submitting them, see https://www.
copyright.gov/recordation/etl.
Declarations of Ownership in Musical Works (DOMWs)
A DOMW is a special type of recordable document available to
certain copyright owners of musical works. For more information
about DOMWs, including the requirements and instructions for
completing and submitting them, see https://www.copyright.gov/
recordation/domw.
note:
Among other requirements, a DOMW
must be accompanied by an electronic title list and be submitted
to a different mailing address than other documents submitted for
recordation. Mail DOMWs to:
Copyright Office–DOMW
P.O. Box 71537
Washington, DC 20024-1537
Recordation process
To be recorded, your submission must com-
ply with the Copyright Act’s statutory requirements (17 U.S.C. §
205) and the Office’s regulations (37 C.F.R. § 201.4) and instruc-
tions. The Copyright Office will examine, process, and index the
document in the public record based on the information you sub-
mit to the Office. The Office will rely on the certifications and in-
formation provided on Form DCS and, if provided, in an accom-
panying electronic title list. The Office will not necessarily confirm
the accuracy of such certifications or information against the sub-
mitted document. The fact that the Office has recorded a docu-
ment is not a determination by the Office of the document’s valid-
ity or legal effect. Recordation of a document by the Copyright
Office is without prejudice to any party claiming that the legal or
formal requirements for recordation have not been met, including
before a court of competent jurisdiction.
Privacy Act Advisory Statement
Please review the Privacy Act
notice at the top of the form. The principal uses of the requested
information are the establishment and maintenance of a public
record and the examination of the form for compliance with the
requirements for recordation. Other routine uses include public
inspection and copying, preparation of public indexes, prepara-
tion of public catalogs of recorded documents, and preparation of
search reports upon request.
note:
Form DCS will be imaged with the submitted document as
part of the public record. Please keep a copy of these instructions
and the completed form so that you may refer to them if the Of-
fice communicates with you regarding your submission.
6
Form DCS (
Document Cover Sheet)
·
Basic Information
Form DCS, Document Cover Sheet · 
Electronic Title List Enclosed and Declaration of Ownership in
a Musical Work checkboxes
If you have enclosed an electronic
title list or if the document is a DOMW, check the appropriate
box(es) on the top of Form DCS. If the document is a DOMW,
the electronic title list box should also be checked because all
DOMWs must be accompanied by an electronic title list.
Item 1: Title and/or registration number of first work pro-
vided in document
This item is used to connect Form DCS and
the document if they become separated.
Item 2: Total number of additional works and alternate
identifiers in document
Provide the total number of different
works and alternate identifiers contained in the document. The
total number of works and alternate identifiers (along with the
total number of legal transactions contained in the document)
determines the recordation filing fee. The first title and/or
registration number provided for a particular work constitutes a
work. If a work is identified by more than one title or registration
number, every additional title and registration number provided
beyond the first counts as an alternate identifier for purposes of
this item and in calculating the proper recordation filing fee.
For example, if a document were to refer to “Harold & Kumar 2
(PAu003086781) a.k.a. Untitled Harold & Kumar sequel a.k.a.
Harold & Kumar Go to Amsterdam,” the first title and registration
number (Harold & Kumar 2 (PAu003086781)) would count as
one work and the two alternate titles would count as two alternate
identifiers.
If a work is described as being part of a larger work, only the
specific work counts, and not the title and/or registration number
for the larger work. For example, if the document were to refer
to “When You Wish Upon a Star from Pinocchio,” the title “When
You Wish Upon a Star” would count as one work, “Pinocchio”
would not count as an additional work or alternate identifier. For
more information about how to calculate works and alternate
identifiers, see 37 C.F.R. § 201.3(c), 84 Fed. Reg. 29,135 (June 21,
2019), and 85 Fed. Reg. 9,374 (Feb. 19, 2020).
Item 3: Amount of fee calculated
Recordation fees are calcu-
lated in accordance with 37 C.F.R. § 201.3(c). For assistance in
determining your fee, use the fee calculator provided at https://
www.copyright.gov/recordation/ and review Calculating Fees for
Recording Documents and Notices of Termination in the Copyright
Office, available at https://www.copyright.gov/circs/circ12a.pdf.
Note that the Office charges different fees depending on whether
your submission includes an electronic title list.
Item 4: Fee enclosed
Check the appropriate box. To charge a
Copyright Office deposit account, provide the deposit account
number and name. If paying by check or money order, note
that the Office only accepts domestic money orders and checks
payable through a U.S. bank with American Bankers Association
routing numbers. International and postal money orders are
not accepted. Make the check or money order payable to
U.S. Copyright Office.
Item 5: Return receipt requested
Check this box to indicate that
you want a return receipt showing that the Office received your
submission. If you check this box, you must also include a second
properly completed copy of Form DCS and a self-addressed post-
age-paid envelope. A return receipt confirms the Office’s receipt
of the submission as of the date indicated, but does not establish
eligibility for, or the date of, recordation.
Item 6: Redacted document
Check the first box if the submitted
document contains any redactions. Permissible redactions are
limited to financial terms, trade secret information, Social Secu-
rity or taxpayer-identification numbers, and financial account
numbers. Any such redactions must be made in accordance with
37 C.F.R. § 201.4(d)(4). Additional types of information may be
redacted on a case-by-case basis if the need for any such redac-
tions is justified to the Office in writing and approved by the Of-
fice. If such a written justification is included in your submission,
check the second box in addition to the first.
Item 7: English translation
The Office accepts and records non-
English language documents and indexing information only if
accompanied by an English translation in conformity with 37
C.F.R. § 201.4(d)(5). Check this box if an English translation of
non-English material is included in your submission.
Item 8: Document type
Check the box that best describes the
document. If you select “Other,” provide a description of the
document.
Item 9: Document’s Date of Execution
Provide the document’s
date of execution. Partial date information may be provided,
but must consist of one of the following options: Month / Day,
Month / Year, or Year only.
Item 10: Party Information
Provide the names of all parties
to the document, including any alternate party names and
name types (e.g., AKA, DBA, FKA, FSO, NKA, OBO, PKA).
Item-by-Item Instructions
Form DCS, Document Cover Sheet · 
When providing this information, provide it exactly as it appears
in your document. If it does not appear in the document, you
may still provide this information. Please also provide the nature
of all parties’ respective roles within the document. There are
many different ways to describe an individual or organization’s
role within the document. When providing party roles, please
use the exact terms as they appear in your document. If they do
not appear in the document, please provide an appropriate role
for each party. Some examples of different roles include: Assignor,
Assignee, Grantor, Grantee, Licensor, Licensee, Executor, Trustee,
Affiant, Declarant, Mortgagor, and Mortgagee.
To illustrate, Company A could be the “Assignor” while Com-
pany B could be the “Assignee”; Company A could be the “Licen-
sor” while Company B could be the “Licensee”; Jane Smith could
be the “Declarant.” A mailing address must also be provided if
submitting a DOMW and may be voluntarily pro- vided for all
other documents. If the document has more than two parties, at-
tach an additional sheet detailing information for the other parties.
Item 11: Remitter Information and Certifications
You, the
individual actually submitting this form and the attached docu-
ment to the Copyright Office, provide your contact information
and make the required remitter certifications by signing your
name and dating the form. You may sign the form electronically.
The Office may use this information to contact you about the
submission and will send a numbered copy of the document as
recorded and certificate of recordation to the provided address if
the document is successfully recorded. Providing a fax number is
optional. To make this certification, you must be either a party to
the document, a successor-in-interest to a party, or a duly autho-
rized agent of a party or successor-in-interest.
Item 12: Document Certifications
Make the required document-
related certifications—the True and Correct Copy Certification
and the Recordation Eligibility Certification—by having them
signed and dated by an appropriate individual. They can be made
either by you (i.e., the remitter identified in Item 11) or another
individual and may be signed electronically. There are two types
of certifications in this item.
The True and Correct Copy Certification pertains to whether
the submitted document is an original or a copy. If it is the origi-
nal document, check the first box. If it is a copy of the original
that is accompanied by an Official Certification, check the second
box. An Official Certification is a certification, by the appropri-
ate governmental official, that the original of the document is on
file in a public office and that the copy of the document submit-
ted for recordation is a true copy of the original. If the submit-
ted document is not the original and is not accompanied by an
Official Certification, a Sworn Certification must be provided
by checking the remaining checkbox declaring that the submit-
ted document is a true and correct copy of the original, signed
document, and signing on the signature line. The certifier must
also indicate their relationship to the document, that is, whether
the certifier is a party, a successor-in-interest to a party, or an
authorized representative of a party or a successor-in-interest.
A “Sworn Certification” is a statement made in accordance with
28 U.S.C. § 1746 that the copy of the document submitted for
recordation is, to the best of the certifier’s knowledge, a true copy
of the original, signed document. Note that where a submitted
document lacks a handwritten, wet signature (such as when it is
signed electronically), the Office considers the document to be
a copy, which must be accompanied by a Sworn Certification or
Official Certification.
The Recordation Eligibility Certification is a certification that
the document satisfies the signature, completeness, legibility, and,
if redacted, redaction requirements for recordation specified in
37 C.F.R. § 201.4. The box next to these certifications must be
checked and a signature must be provided below.
If two different individuals are making each of the two types
of certifications, complete and attach an additional copy of page 3
of the form with the appropriate boxes checked to indicate which
individual is making which certifications. If someone other than
you is making the certifications in this item, his or her name, title,
and organization must be provided.
For more information about the Copyright Oce’s recor-
dation requirements, see 37 C.F.R. § 201.4 and 82 Fed. Reg.
52,213 (Nov. 13, 2017).
Volume Document
SR#
Date of recordation
(
    
)
     
Electronic Title List Enclosed
Declaration of Ownership in Musical Works (DOMW)
If DOMW is checked, an electronic title list must be enclosed
and “Electronic Title List Enclosed” must also be checked.
Privacy Act Notice: Sections 205 and 705 of title 17 of the United States
Code authorize the Copyright Oce to collect the personally identifying
information (PII) requested on this form and provided in the document
submitted for recordation or other materials accompanying the submission.
PII is any personal information that can be used to identify, contact, or trace
an individual, such as names, addresses, and telephone numbers. By providing
this information, including, but not limited to, providing it in any document or
other le, you are agreeing to the routine use of it to establish and maintain a
public record, which includes appearing in the Oce’s paper and online public
records and indexes, including the Oce’s online catalog, and in search reports
prepared for the public. If you do not provide the information requested,
recordation may be refused or delayed, and you may not be entitled to certain
relief, remedies, and benets under the copyright law.
Copyright Office fees are subject to change. For current fees, check the Copyright Office website at
www.copyright.gov, write the Copy right Office, or call (202) 707-3000 or 1-877-476-0778 (toll free).
To the Register of Copyrights: Please record the accompanying document.
IMPORTANT: Please read all instructions for completing this form. If you have enclosed an electronic title list or if your document is a
Declaration of Ownership in a Musical Work (DOMW), check the appropriate box(es) on the top of this page.
1
Title and/or registration number
of rst work provided in document
2
Total number of additional
works and alternate identiers
in document
3
Amount of fee calculated $ (Fees are to be calculated in accordance with 37 C.F.R. § 201.3(c))
4
Fee enclosed Check Money Order
Fee authorized to be charged to Copyright Oce deposit account
Deposit account number
Deposit account name
5
Return receipt requested If checked, please enclose a second completed copy of this form and a self-addressed
postage-paid envelope
6
Redacted document Check if document is redacted
Check if a written justication for redacted material not enumerated
in 37 C.F.R. § 201.4(d)(4)(i) is enclosed
7
English translation Check if an English translation of non-English material is enclosed
Send to: Library of Congress, Copyright Oce–DOC, LM 433, 101 Independence Avenue SE, Washington, DC 20559-6000
If submitting a DOMW, send to: Copyright Oce–DOMW, P.O. Box 71537, Washington, DC 20024-1537
Form DCS (Document Cover Sheet)
6
For Recordation of Documents under 17 U.S.C. §205
   
form dcs  
8
Document type Assignment Exclusive License Non-Exclusive License
Change of Address Mortgage or Security Agreement
Adavit/Declaration/Certication Court Order Will
Change of Name (e.g., via merger agreement, amendment to articles of incorporation)
Other
9
Document’s Date of Execution
10 Party Information
Name
Relationship
Number/Street Apt/Suite
City State Zip
Name
Relationship
Number/Street Apt/Suite
City State Zip
List continued on an attached additional sheet
11
Remitter Information
and Certications
(Provide the names of all parties to
the document and the nature of
their respective relationships to the
document, including which party,
if any, is the current copyright
owner of the works to which the
document pertains. A mailing
address must also be provided if
submitting a DOMW and may be
voluntarily provided for all other
documents. If more space is needed,
attach an additional sheet.)
(Check the one that best describes
the document.)
I certify under penalty of perjury under the laws of the United States of America that I have been given
appropriate authority to submit this cover sheet, accompanying document, and any other enclosed
materials to the U.S. Copyright Oce for recordation, and that all information I have submitted is true,
accurate, and complete to the best of my knowledge, information, and belief, and is provided in good faith.
I understand that any falsication or misrepresentation may subject me to civil or criminal liability.
By signing my name below, I acknowledge that I have read and agree to these conditions.
Signature Date
Name
Title/Organization
Number/Street Apt/Suite
City State Zip
Phone number Fax number
Email
form dcs  
(You, the individual actually
submitting this form and the
attached document to the
Copyright Oce, provide your
contact information and make the
required remitter certications by
signing your name. The Oce may
use this information to contact
you about the submission and will
send the certicate of recordation
to the provided address if the
document is successfully recorded.)
form dcs reviewed: 03
⁄
2020 Printed on recycled paper  
12
Document Certications True and Correct Copy Certication
Original document enclosed Ocial certication enclosed
Sworn certication: I certify under penalty of perjury that the accompanying document being
submitted to the U.S. Copyright Oce for recordation is, to the best of my knowledge, a true and correct
copy of the original, signed document.
Recordation Eligibility Certication
I certify under penalty of perjury under the laws of the United States of America that the accompanying
document being submitted to the U.S. Copyright Oce for recordation, to the best of my knowledge,
is a transfer of copyright ownership or other document pertaining to a copyright and satises all
requirements for recordation, including the signature, completeness, legibility, and, if redacted,
redaction requirements specied in 37 CFR § 201.4.
I understand that any falsication or misrepresentation may subject me to civil or criminal liability.
By signing my name below, I acknowledge that I have read and agree to these conditions.
Signature Date
Certier Information Name
Title/Organization
(These certications can be
made either by the remitter
identied on the previous page or
another individual. If a dierent
individual is making each
document certication, complete
and attach an additional copy of
this page.)
(This information is only required
if an individual other than
the remitter identied on the
previous page is making the
above certications.)
party
successor-in-interest to a party
Describe your relationship to the document or the original parties to
the document:
authorized representative of a party
Which party do you represent:
authorized representative of a successor-in-interest to a party
Which successor-in-interest do you represent:
Describe the successor’s relationship to the document or the original
parties to the document:
I am a(n)
(select one)
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Formdcs Form DCS (Document Cover Sheet)

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Completed 10 July 2020

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