Read all of the instructions below before completing this form.
When to use this form
Use Form TCS to submit notices of ter-
mination to the Copyright Office for recordation under section
203, 304(c), or 304(d) of the Copyright Act. Use of Form TCS is
mandatory, and a properly completed Form TCS must accom-
pany all notices submitted to the Office under 17 U.S.C. §§ 203,
304(c), or 304(d).
When not to use this form
Do not use Form TCS when submit-
ting any other type of document to the Office, such as transfers of
copyright ownership, 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 TCS. All fields are required to the extent applicable, and all
information should be typed or printed. Include one completed
and signed Form TCS for each notice being submitted for recor-
dation. The Office may reject any notice submitted for recorda-
tion that is not accompanied by Form TCS or is accompanied by
an incomplete or improperly prepared Form TCS.
Submission requirements
Submit together in the same envelope
or package: (1) a properly prepared Form TCS; (2) the notice of
termination to be recorded; (3) the proper filing fee; and (4) any
additional material being provided in connection with your sub-
mission, such as a statement of service or an additional copy of
this completed form and a self-addressed postage-paid envelope
for a return receipt. Absent special arrangement with the Office,
the Office reserves the right to not process your submission un-
less all of the items necessary for processing are received together.
Mail your submission to:
Copyright Office–Notices of Termination
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. §§
203, 304(c), or 304(d)) and the Offices regulations (37 C.F.R. §
201.10) and instructions. The Copyright Office will examine, pro-
cess, and index the notice of termination in the public record
based on the information you submit to the Office. The Office will
rely on the certifications and information provided on Form TCS
and, if provided, in an accompanying statement of service. The
Office will not necessarily confirm the accuracy of such certifica-
tions or information against the submitted notice. The fact that
the Office has recorded a notice is not a determination by the Of-
fice of the notice’s validity or legal effect. Recordation of a notice
of termination by the Copyright Office is without prejudice to any
party claiming that the legal or formal requirements for effectuat-
ing termination (including the requirements pertaining to service
and 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 TCS will be imaged with the submitted notice 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 Office
communicates with you regarding your submission.
6
Form TCS (Notice of Termination Cover Sheet)
·
Basic Information
Item-by-Item Instructions
Item 1: Title of first work provided in notice
This item is used
to connect Form TCS and the notice of termination if they be-
come separated.
Item 2: Total number of titles in notice
Provide the total
number of different titles contained in the notice—not the total
number of works. The total number of titles determines the recor-
dation 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 notice 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 notice 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
Form TCS, Notice of Termination Cover Sheet · 2
once, even if repeated multiple times throughout the same notice,
note that where a notice 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 notice 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: 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.
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 TCS and a self-addressed post-
age-paid envelope. A return receipt confirms the Offices receipt
of the submission as of the date indicated, but does not establish
eligibility for, or the date of, recordation.
Item 6: Notice of termination being filed under
Check the box
next to the statutory termination provision that the submitted
notice is being filed under, section 203, 304(c), or 304(d). Infor-
mation about termination, including the differences between
these provisions can be found on the Office’s website at https://
www.copyright.gov/recordation/termination.html.
Item 7: Gap Grant
Check this box if the submitted notice is
terminating a gap grant under 37 C.F.R. § 201.10(f)(1)(ii)(C). For
more information about gap grants, see § 2310.3(C)(3) of the
Compendium of U.S. Copyright Office Practices.
Item 8: Effective date of termination
Provide the effective date
of termination. Note that the notice of termination must be re-
corded with the Office prior to the effective date of termination.
Item 9: Date of service
Provide the date of service of the submit-
ted notice upon the grantee(s)/successor(s)-in-title.
Item 10: Manner of service
Describe the manner of service of
the submitted notice upon the grantee(s)/successor(s)-in-title. For
example, “personal service” or “first class mail.
Item 11: Terminating Party
List each terminating party and the
nature of such party’s termination interest under section 203,
304(c), or 304(d). For example, “John Smith (sole author)”; or
“Nancy Jones (author’s executor)”; or “Jane Smith (author’s wid-
ow), Mark Smith (author’s child), Jessica Smith (author’s child),
and Richard Smith (child of author’s deceased child).
Item 12: Grantee
List each grantee whose rights are being termi-
nated or such grantees successor-in-title. Identify any successor-
in-title as such.
Item 13: Remitter Information and Certifications
You, the in-
dividual actually submitting this form and the attached notice of
termination to the Copyright Office, provide your contact infor-
mation and make the required remitter certifications by signing
your name and dating the form. You may sign the form electroni-
cally. The Office may use this information to contact you about
the submission and will send a numbered copy of the notice as
recorded and certificate of recordation to the provided address
if the notice is successfully recorded. Providing a fax number is
optional. If you are not one of the terminating parties, you must
state which terminating party or parties you are a duly autho-
rized representative of.
Item 14: Notice Certifications
Make the required notice-related
certifications by having them signed and dated by an appropri-
ate individual. They can be made either by you (i.e., the remitter
identified in Item 13) or another individual and may be signed
electronically. If someone other than you is making the certifica-
tions in this item, he or she may sign the same copy of page 2 of
the form as you did in Item 13, or he or she may sign a separate
copy of page 2 of the form. If someone other than you is making
the certifications in this item, his or her name, title, and organiza-
tion must be provided. Additionally, if such individual is not one
of the terminating parties, he or she must state which terminating
party or parties he or she is a duly authorized representative of.
For more information about the Copyright Oce’s recorda-
tion requirements, see 37 C.F.R. § 201.10(f) and 82 Fed. Reg.
52,213 (Nov. 13, 2017).
Volume Document
SR#
Date of recordation
(
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)
     
Privacy Act Notice: Sections 203, 304(c), 304(d) 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 notice of termination.
1
Title of rst work provided
in notice
2
Total number of titles in notice
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
Notice of termination
being led under §203 §304(c) §304(d)
7
Gap Grant Check if the notice is terminating a gap grant under 37 C.F.R. § 201.10(f)(1)(ii)(C)
8
Eective date of termination
9
Date of service
10
Manner of service
Send to: Copyright Oce–Notices of Termination, P.O. Box 71537, Washington, DC 20024-1537
Form TCS (Notice of Termination Cover Sheet)
6
For Recordation of Notices of Termination under 17 U.S.C. §§ 203, 304(c), 304(d)
   
form tcs  
DO NOT WRITE ABOVE THIS LINE • SEE INSTRUCTIONS
11
Terminating Party
12 Grantee
13
Remitter Information
and Certications
(List all grantees or successors-in-title,
and if successors, state that they are
successors.)
(List all terminating parties and the
nature of their termination interests.)
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 notice of termination, 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 one of the terminating parties listed above, state which terminating party
or parties you are a duly authorized representative of.
form tcs reviewed: 12
2017 Printed on recycled paper  
(You, the individual actually
submitting this form and the
attached notice of termination 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 notice is
successfully recorded.)
14
Notice Certications I certify under penalty of perjury under the laws of the United States of America that the accompanying
notice of termination is a true, correct, complete, and legible copy of the signed notice of termination as
served on the grantee or successor-in-title.
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 one of the terminating parties listed above, state which terminating
party or parties the certier is a duly authorized representative of.
(These certications can be made
either by the remitter identied
above or another individual.)
(This information is only required
if an individual other than the
remitter identied above is making
the above certications.)