Free Form DC 072006.indd - Federal

5 Form DC

To Correct a Design Registration

united states copyright office

registration number

A B

do not write above this line.

m a k e a n d m o d e l o f t h e v e s s e l t h at e m b o d i e s t h e d e s i g n
Registration number of the basic registration Name(s) of designer(s) Name(s) of owner(s) (if different than designer(s) ) Year of basic registration

l o c at i o n a n d n at u r e o f i n c o r r e c t i n f o r m at i o n
Please provide the location and nature of the clerical or typographical error, and set forth the incorrect information as it appears in the basic registration and the corrected information. Space number Incorrect information as it appears: Space heading or description Corrected information:

Explanation of correction(s)

C

correspondence
Give name and address to which correspondence about this application should be sent. Name Address Phone ( ) Fax ( ) Email

D

d e p o s i t acc o u n t
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

form dc received funds received date examined by correspondence Yes

ò

E

do not write above this line.

c e r t i f i c at i o n *
I, the undersigned, hereby certify that I am the (check only one)

ò ò

owner of the registered design duly authorized agent of

, the owner of the registered design,

and that the statements made by me in this application are correct to the best of my knowledge.
typed or printed name date

h a n d w r it t e n s i g n atu r e

F

m a i l i n g i n f o r m at i o n
Certificate will be mailed in window envelope to this address:
n am e n u m b e r / st r e e t / a p t c it y / stat e / z i p

you must: · Complete all necessary spaces · Sign your application in space E 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 SE Washington, DC 20559-6000

* 17 USC §1327. Penalty for false representation. "Whoever knowingly makes a false representation materially affecting the rights obtainable under this chapter for the purpose of obtaining registration of a design under this chapter shall pay a penalty of not less than $500 and not more than $1,000, and any rights or privileges that individual may have in the design under this chapter shall be forfeited."

U.S. Copyright Office · Library of Congress · 101 Independence Avenue SE · Washington, DC 20559-6000 · www.copyright.gov
form dc rev: 07 / 2006 print: 07 / 2006 ­ xx,000 Printed on recycled paper U. S. Government Printing Office: 2006-320-xxx / 60,xxx