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Questionnaire for Copyright
TITLE OF THIS WORK:   
PREVIOUS OR ALTERNATIVE TITLES:   
PUBLICATION AS A CONTRIBUTION (If this work was published as a contribution to a periodical, serial, or collection, give information about the collective work in which the contribution appeared.
TITLE OF COLLECTIVE WORK: 
If published in a periodical or serial give:
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Number
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On Pages

1 Name of Author
Date of Birth and Death
Year Born Year Died
Was this contribution to the work a "work made for hire"

AUTHOR'S NATIONALITY OR DOMICILE Name of Country

WAS THIS AUTHOR'S CONTRIBUTION TO THE WORK
Yes
OR: Citizen of
Anonymous? Yes No
No
Domiciled in
Pseudonymous? Yes No
NATURE OF AUTHORSHIP Briefly describe nature of material created by this author in which copyright is claimed?
2 Name of Author
Date of Birth and Death
Year Born Year Died
Was this contribution to the work a "work made for hire"

AUTHOR'S NATIONALITY OR DOMICILE Name of Country

WAS THIS AUTHOR'S CONTRIBUTION TO THE WORK
Yes
OR: Citizen of
Anonymous? Yes No
No
Domiciled in
Pseudonymous? Yes No
NATURE OF AUTHORSHIP Briefly describe nature of material created by this author in which copyright is claimed?
3 Name of Author
Date of Birth and Death
Year Born Year Died
Was this contribution to the work a "work made for hire"

AUTHOR'S NATIONALITY OR DOMICILE Name of Country

WAS THIS AUTHOR'S CONTRIBUTION TO THE WORK
Yes
OR: Citizen of
Anonymous? Yes No
No
Domiciled in
Pseudonymous? Yes No
NATURE OF AUTHORSHIP Briefly describe nature of material created by this author in which copyright is claimed?

YEAR IN WHICH CREATION OF THIS WORK WAS COMPLETED

DATE AND NATION OF FIRST PUBLICATION OF THIS PARTICULAR WORK (Complete this information ONLY if this work has been published)
Month Day Year
Nation

COPYRIGHT CLAIMANT(S) Name and address must be given even if the claimant is the same as the author

TRANSFER If the claimant(s) name on Copyright Claimant is (are) different from the author(s) named on 1, give a brief statement of how the claimant(s) obtain ownership of the copyright.

PREVIOUS REGISTRATION Has registration for this work, or for an earlier version of this work, already been made in the Copyright Office?

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This is the first published edition of a work previously registered in unpublished form.

This is the first application submitted by this author as copyright claimant.

This is a change version of the work.

               If your answer is "YES," give: Previous Registration Number Year of Registration

 
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