Fillable US Copyright Office - Form DCS

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US Copyright Office - Form DCS

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The US Copyright Office - Form DCS form is 6 pages long and contains:

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  • 11 check-boxes
  • 64 other fields

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File type: PDF

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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 docu-
ments 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 document 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 recording 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, online service provider agent designations, identifi-
cation of anonymous/pseudonymous authors, author death state-
ments, visual arts registry statements, shareware registry state-
ments, 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, type, registration numbers, and authorship
information. Submitting an electronic title list is optional, but can
significantly shorten the Office’s processing time for recording a
document. Consequently, the Office offers a reduced filing fee for
submissions that include them. For more information about elec-
tronic 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 · 2
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 of first work provided in document
This item is
used to connect Form DCS and the document if they become
separated.
Item 2: Total number of titles in document
Provide the total
number of different titles contained in the document—not the
total number of works. The total number of titles (along with the
total number of legal transactions contained in the document)
determines the recordation filing fee. If a work has more than
one title, all titles for the work are counted for purposes of this
item and in calculating the proper recordation filing fee. For
example, if a document were to refer to “Star Wars a.k.a Episode
IV a.k.a. A New Hope,” each of those three titles would count.
Additionally, if a work is described as being part of a larger work,
both the specific work and the larger work count. For example,
if the document were to refer to “When You Wish Upon a Star
from Pinocchio,” each of those two titles would count. While
each distinct title of a particular work only counts once, even if
repeated multiple times throughout the same document, note
that where a document makes reference to different registration
numbers, issue numbers, volume numbers, chapters, or the like,
each one counts as a separate title. For example, if a document
were to refer to “Fan Club News, Vol. 1, No. 3 (June 2011)” and
“Fan Club News, Vol. 1, No. 4 (July 2011),” each of those two titles
would count. For more information about how to calculate titles,
see § 2309.11(B) of the Compendium of U.S. Copyright Office
Practices.
Item 3: Page number(s) in document where titles information
can be located
Provide all relevant page numbers, including if
the information is contained in an appendix, schedule, or other
attachment. This item is to help Office staff to more easily locate
information about the works to which the document pertains.
Item 4: 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 5: 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 6: 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 7: 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 8: 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 9: Document type
Check the one that best describes the
document. If you select “Other,” provide a description of the
document.
Item 10: Document’s Date of Execution
Provide the document’s
date of execution.
Item 11: Party Information
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 (i.e., as
of the date of your submission) copyright owner of the works to
which the document pertains. For example, Company A could be
the “assignor” while Company B could be the “assignee, copyright
owner”; Company A could be the “licensor, copyright owner”
while Company B could be the “licensee”; Jane Smith could be
the “declarant, copyright owner.” A mailing address must also be
Item-by-Item Instructions
Form DCS, Document Cover Sheet · 3
provided if submitting a DOMW and may be voluntarily pro-
vided for all other documents. If the document has more than
two parties, attach an additional sheet detailing information for
the other parties.
Item 12: Remitter Information and Certifications
You, the indi-
vidual actually submitting this form and the attached document
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 submis-
sion and will send a numbered copy of the document as recorded
and certificate of recordation to the provided address if the docu-
ment is successfully recorded. Providing a fax number is optional.
If you are not a party to the document, you must describe your
relationship to the document or the original parties to the docu-
ment. For example, state which party you are a duly authorized
agent of, which party you are a successor-in-interest to, or which
successor-in-interest you are a duly authorized agent of.
Item 13: Document Certifications
Make the required document-
related certifications by having them signed and dated by an
appropriate individual. They can be made either by you (i.e., the
remitter identified in Item 12) or another individual and may be
signed electronically. There are two types of certifications in this
item. The first is that the document satisfies the signature, com-
pleteness, 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.
The second type of certification in this item pertains to
whether the submitted document is an original or a copy.
If it is an original document, check the appropriate box. If it
is a copy that is accompanied by an official certification (i.e.,
a certification, by the appropriate governmental official, that
the original of the document is on file in a public office and
that the copy of the document submitted for recordation is
a true copy of the original), check the appropriate box. If the
submitted document is not an original and is not accompa-
nied by an official certification, a sworn certification must
be provided by checking the remaining checkbox declaring
that the submitted document is a true and correct 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 or official
certification.
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 provid-
ed. Additionally, if such individual is not a party to the docu-
ment, his or her relationship to the document or the original
parties to the document must be described. For example, state
which party he or she is a duly authorized agent of, which par-
ty he or she is a successor-in-interest to, or which successor-
in-interest he or she is a duly authorized agent of.
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 a Musical Work (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. 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, 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 of rst work provided
in document
2
Total number of titles
in document
3 Page number(s) in document
where titles information
can be located
4
Amount of fee calculated $ (Fees are to be calculated in accordance with 37 C.F.R. § 201.3(c))
5
Fee enclosed Check Money Order
Fee authorized to be charged to Copyright Oce deposit account
Deposit account number
Deposit account name
6
Return receipt requested If checked, please enclose a second completed copy of this form and a self-addressed
postage-paid envelope
7
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
8
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  
9
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
10
Document’s Date of Execution
11 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
12
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 all information I have submitted is
true, accurate, and complete to the best of my knowledge.
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
If you are not a party to the document, describe your relationship to the document or
the original parties to the document (e.g., duly authorized agent of a party, successor-in-
interest to a party, duly authorized agent of a successor-in-interest to a party).
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: 12
⁄
2017 Printed on recycled paper  
13
Document Certications Original document enclosed Ocial certication enclosed
I certify under penalty of perjury under the laws of the United States of America that the following
is true and correct: (Check the box next to each certication being made. The rst is always required.
The second is required if an original document or ocial certication is not enclosed. If a dierent
individual is making each one, complete and attach an additional copy of this page.)
The accompanying document being submitted to the U.S. Copyright Oce for recordation satises,
to the best of my knowledge, the signature, completeness, legibility, and, if redacted, redaction
requirements for recordation as specied in 37 C.F.R. § 201.4.
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.
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
If the certier is not a party to the document, describe the certier’s relationship to the
document or the original parties to the document (e.g., duly authorized agent of a party,
successor-in-interest to a party, duly authorized agent of a successor-in-interest to a party).
(These certications can be made
either by the remitter identied
on the previous page or another
individual.)
(This information is only required
if an individual other than
the remitter identied on the
previous page is making the
above certications.)
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US Copyright Office - Form DCS

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Completed 26 May 2020

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