For Renewal of Work (United States)
This is a copyright form for renewal of a work. The form provided here is simply a sample of what the actual Form RE looks like.
FORM RE
For Renewal of a Work
UNITED STATES COPYRIGHT OFFICE
REGISTRATION NUMBER ___________________________
EFFECTIVE DATE OF RENEWAL REGISTRATION
_______________________ Month _______________ Day __________ Year
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET (FORM RE/CON).
1 RENEWAL CLAIMANT(S), ADDRESS(ES), AND STATEMENT OF CLAIM (See Instructions) (Use appropriate statement from instructions)
a Name ___________________________
Address ___________________________
___________________________
Claiming as ___________________________
b Name ___________________________
Address ___________________________
___________________________
Claiming as ___________________________
c Name ___________________________
Address ___________________________
___________________________
Claiming as ___________________________
2 TITLE OF WORK IN WHICH RENEWAL IS CLAIMED
___________________________
RENEWABLE MATTER ___________________________
PUBLICATION AS A CONTRIBUTION If this work was published as a contribution to a periodical, serial, or other composite work, give information about the collective work in which the contribution appeared.
Title of Collective Work ___________________________
If published in a periodical or serial give:
___________________________ Volume
___________________________ Number
___________________________ Issue Date
3 AUTHOR(S) OF RENEWABLE MATTER ___________________________
4 ORIGINAL REGISTRATION NUMBER ___________________________
ORIGINAL COPYRIGHT CLAIMANT ___________________________
ORIGINAL DATE OF COPYRIGHT ___________________________
If the original registration for this work was made in unpublished form, give:
DATE OF PUBLICATION:
___________________ (Month) ________________ (Day) ________ (Year)
OR
If the original registration for this work was made in published form, give:
DATE OF REGISTRATION:
__________________ (Month) __________________ (Day) _________ (Year)
• Complete all applicable spaces (numbers 5-8) on the reverse side of this page.
• See detailed instructions.
• Sign the form at space 7.
RENEWAL APPLICATION RECEIVED ___________________________
CORRESPONDENCE ❑ YES
EXAMINED BY ___________________________
CHECKED BY ___________________________
FUNDS RECEIVED ___________________________
FOR COPYRIGHT OFFICE USE ONLY
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET (FORM RE/CON).
5 RENEWAL FOR GROUP OF WORKS BY SAME AUTHOR: To make a single registration for a group of works by the same individual author published as contributions to periodicals (see instructions), give full information about each contribution. If more space is needed, request continuation sheet (Form RE/CON).
a Title of Contribution: ___________________________
Title of Periodical: ___________________________
Vol: ___________________________
No: ___________________________
Issue Date: ___________________________
Date of Publication: ___________________________
Registration Number: ___________________________
b Title of Contribution: ___________________________
Title of Periodical: ___________________________
Vol: ___________________________
No: ___________________________
Issue Date: ___________________________
Date of Publication: ___________________________
Registration Number: ___________________________
6 DEPOSIT ACCOUNT: If the registration fee is to be charged to a Deposit Account established in the Copyright Office, give name and number of Account.
Name ___________________________
Account Number ___________________________
Area code and daytime telephone number ___________________________
CORRESPONDENCE: Give name and address to which correspondence about this application should be sent.
Name ___________________________
Address ___________________________
___________________________
Fax number ___________________________
Email Address ___________________________
7 CERTIFICATION* I, the undersigned, hereby certify that I am the: (Check one)
❑ renewal claimant
❑ duly authorized agent of ___________________________ (Name of renewal claimant)
of the work identified in this application and that the statements made by me in this application are correct to the best of my knowledge.
Typed or printed name ___________________________
Date ___________________________
Handwritten signature (X) ___________________________
8 Certificate will be mailed in window envelope to this address:
Name ___________________________
Number/Street/Apt ___________________________
City/State/ZIP ___________________________
YOU MUST:
• Complete all necessary spaces
• Sign your application in space 7
SEND ALL ELEMENTS IN THE SAME PACKAGE:
1. Application form
2. Nonrefundable filing fee in check or money order payable to Register of Copyrights
MAIL TO:
Library of Congress
Copyright Office
101 Independence Avenue, S.E.
Washington, D.C. 20559-6000