For a Nondramatic Literary Work (United States)
This is a copyright short form for a nondramatic literary work. The form provided here is simply a sample of what the actual Form TXS looks like.
For a Nondramatic Literary Work
UNITED STATES COPYRIGHT OFFICE
EFFECTIVE DATE OF REGISTRATION
________________ Month __________________ Day __________ Year
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.
1 TITLE OF THIS WORK: Alternative title or tile of larger work in which this work was published: ___________________________
2 NAME AND ADDRESS OF AUTHOR AND OWNER OF THE COPYRIGHT: Nationality or domicile:
3 YEAR OF CREATION: ___________________________
This information must be given in all cases.
4 IF WORK HAS BEEN PUBLISHED, DATA AND NATION OF PUBLICATION
b Nation ___________________________
5 TYPE OF AUTHORSHIP IN THIS WORK: Check all that this author created.
____ Text (includes fiction, nonfiction, poetry, computer programs, etc.)
____ Compilation of terms or data
SIGNATURE: Registration cannot be completed without a signature. I certify that the statements made by me in this application are correct to the best of my knowledge* Check One:
____ Authorized agent
7 NAME AND ADDRESS OF PERSON TO CONTACT FOR RIGHTS AND PERMISSIONS:
8 Certificate will be mailed in window envelope to this address:
9 Deposit Account # ___________________________