This form, with all elds below completed, is required to remove a sound recording xed before February 15, 1972 (“Pre-1972 Sound Recording”)
that has been indexed in the Copyright Oce’s database of schedules of Pre-1972 Sound Recordings
(available at https://www.copyright.gov/music-modernization/pre1972-soundrecordings/search-soundrecordings.html).
A removal may be made if there was a substantive defect in the schedule regarding the Pre-1972 Sound Recording at the time the schedule
was submitted to the Oce, or, upon a showing of good cause, at the discretion of the Copyright Oce. The Oce will keep a record of Pre-
1972 Sound Recordings removed from the Oce’s database, and a timestamp of when each deletion occurs.
5
Removal Request Form –
Indexed Pre-1972 Sound Recording
Privacy Act Notice:Section 1401 of title 17 of the United States Code authorizes the Copyright Office to collect the personally identifying information (PII) requested on this form in order
to process your Removal Form. PII is any personal information that can be used to identify or contact an individual, such as names, addresses, and telephone numbers. By providing PII,
you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Office’s public indexes. The effects of not providing the PII requested are
that it may delay the processing of your Removal Form, and it may affect the legal sufficiency of the filing, a determination that would be made by a court of law.
1
Title of Pre-1972 Sound Recording to be removed from the Oce’s database of schedules of Pre-1972 Sound Recordings:
2
Featured artist(s) of Pre-1972 Sound Recording to be removed from the Oce’s database of schedules of Pre-1972 Sound Recordings:
3
The unique identier assigned to the Pre-1972 Sound Recording in the Copyright Oce’s database of schedules of Pre-1972 Sound Recordings:
(The unique identier for a Pre-1972 Sound Recording can be located in Oce’s database of Pre-1972 Schedules by clicking the “More Info” button in the
line entry for that sound recording, or by downloading and exporting data for that sound recording from the database into an Excel spreadsheet.)
4
Total applicable fees are $75. (Fees are in accordance with 37 C.F.R. §201.3(c).)
5
Deposit account name:
(If you wish to pay using a credit card, indicate “pay by credit card” in response to questions 5 and 6. The Oce will contact you to obtain your credit card information.)
6
Deposit account number:
7
Remitter Information and Certications
(You, the individual actually submitting this form and the attached document to the Copyright Oce, provide your contact information and make the required
remitter certications by signing your name. The Oce may use this information to contact you about the submission.)
I certify that I have the appropriate authority to submit this electronically led Removal Form, and declare under penalty of law that all information submitted
to the Oce is true, accurate, and complete to the best of my knowledge, information, and belief, and is made in good faith.
I understand that any falsication 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:
Street Address (Number/Street/City/State/Zip):
Telephone Number: Email Address:
– -1972 : /
SR#:
Approved By:
Signature:
Date Filed:
