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Copyright Office fees are subject to change. For current fees, check the Copyright Office website at www.copyright.gov, write the Copyright Office, or call (202) 707-3000.
3
Form PA
Page 13 of 24
For a Work of Performing Arts
UNITED STATES COPYRIGHT OFFICE
REGISTRATION NUMBER
PA
PAU
EFFECTIVE DATE OF REGISTRATION
Month
Day
Year
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.
1 2
a
TITLE OF THIS WORK
Shacked Up
PREVIOUS OR ALTERNATIVE TITLES
NATURE OF THIS WORK See instructions
Motion Picture
NAME OF AUTHOR DATES OF BIRTH AND DEATH Year Born Year Died WAS THIS AUTHOR'S CONTRIBUTION TO If the answer to either THE WORK
Anonymous? Pseudonymous? Yes Yes No No
of these questions is "Yes," see detailed instructions.
Io Group, Inc. / d.b.a. Titan Media
Was this contribution to the work a "work made for hire"? Yes No
AUTHOR'S NATIONALITY OR DOMICILE
Name of Country
OR
{
Citizen of Domiciled in
NOTE
Under the law, the "author" of a "work made for hire" is generally the employer, not the employee (see instructions). For any part of this work that was "made for hire" check "Yes" in the space provided, give the employer (or other person for whom the work was prepared) as "Author" of that part, and leave the space for dates of birth and death blank.
NATURE OF AUTHORSHIP Briefly describe nature of material created by this author in which copyright is claimed. NAME OF AUTHOR DATES OF BIRTH AND DEATH Year Born Year Died AUTHOR'S NATIONALITY OR DOMICILE
Name of Country
b
Was this contribution to the work a "work made for hire"? Yes No
OR
{
WAS THIS AUTHOR'S CONTRIBUTION TO If the answer to either THE WORK
Anonymous? Pseudonymous? Yes Yes No No
of these questions is "Yes," see detailed instructions.
Citizen of Domiciled in
NATURE OF AUTHORSHIP Briefly describe nature of material created by this author in which copyright is claimed. NAME OF AUTHOR DATES OF BIRTH AND DEATH Year Born Year Died AUTHOR'S NATIONALITY OR DOMICILE
Name of Country
c
Was this contribution to the work a "work made for hire"? Yes No
OR
{
WAS THIS AUTHOR'S CONTRIBUTION TO If the answer to either THE WORK
Anonymous? Pseudonymous? Yes Yes No No
of these questions is "Yes," see detailed instructions.
Citizen of Domiciled in
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 This information DATE AND NATION OF FIRST PUBLICATION OF THIS PARTICULAR WORK
Complete this information ONLY if this work has been published. Month
DO NOT WRITE HERE OFFICE USE ONLY
3 4
a
2007
must be given Year in all cases.
b
July United States
Day
31
Year
2007
Nation
COPYRIGHT CLAIMANT(S) Name and address must be given even if the claimant is the same as
the author given in space 2.
APPLICATION RECEIVED ONE DEPOSIT RECEIVED
See instructions before completing this space.
Io Group, Inc. / d.b.a. Titan Media, 69 Converse Street, San Francisco, CA 94103
space 2, give a brief statement of how the claimant(s) obtained ownership of the copyright.
TWO DEPOSITS RECEIVED
TRANSFER If the claimant(s) named here in space 4 is (are) different from the author(s) named in
FUNDS RECEIVED
MORE ON BACK
· Complete all applicable spaces (numbers 5-9) on the reverse side of this page. · See detailed instructions. · Sign the form at line 8.
DO NOT WRITE HERE Page 1 of pages
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EXAMINED BY CHECKED BY
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FORM PA
Yes
CORRESPONDENCE
FOR COPYRIGHT OFFICE USE ONLY
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. PREVIOUS REGISTRATION Has registration for this work, or for an earlier version of this work, already been made in the Copyright Office?
Yes a. b. c. No If your answer is "Yes," why is another registration being sought? (Check appropriate box.) If your answer is No, do not check box A, B, or C. 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 changed version of the work, as shown by space 6 on this application. Year of Registration
5
a b a b
See instructions before completing this space.
If your answer is "Yes," give: Previous Registration Number
DERIVATIVE WORK OR COMPILATION Complete both space 6a and 6b for a derivative work; complete only 6b for a compilation.
Preexisting Material Identify any preexisting work or works that this work is based on or incorporates.
6 7 8 9
Material Added to This Work Give a brief, general statement of the material that has been added to this work and in which copyright is claimed.
Name
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.
Account Number
CORRESPONDENCE Give name and address to which correspondence about this application should be sent. Name/Address/Apt/City/State/ZIP
Io Group, Inc. / d.b.a. Titan Media, 69 Converse Street, San Francisco, CA 94103
Area code and daytime telephone number Email (
415
)
487-1211 x:38
Fax number
(
415
)
252-7747
[email protected]
Check only one
CERTIFICATION* I, the undersigned, hereby certify that I am the
{
author other copyright claimant owner of exclusive right(s) authorized agent of
Name of author or other copyright claimant, or owner of exclusive right(s)
Io Group, Inc. / Titan Media
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 and date If this application gives a date of publication in space 3, do not sign and submit it before that date.
Brian Ashby
Date
Certificate will be mailed in window envelope to this address:
Handwritten signature (X)
x
Name YOU MUST: · Complete all necessary spaces · Sign your application in space 8 SEND ALL 3 ELEMENTS IN THE SAME PACKAGE: 1. Application form 2. Nonrefundable filing fee in check or money order payable to Register of Copyrights 3. Deposit material MAIL TO: Library of Congress Copyright Office 101 Independence Avenue, S.E. Washington, D.C. 20559-6000
Io Group, Inc. / Titan Media
Number/Street/Apt
69 Converse Street
City/State/ZIP
San Francisco, CA 94103
Fees are subject to change. For current fees, check the Copyright Office website at www.copyright.gov, write the Copyright Office, or call (202) 707-3000.
*17 U.S.C. § 506(e): Any person who knowingly makes a false representation of a material fact in the application for copyright registration provided for by section 409, or in any written statement filed in connection with the application, shall be fined not more than $2,500. Rev: June 2002--20,000 Web Rev: June 2002 E Printed on recycled paper U.S. Government Printing Office: 2000-461-113/20,021
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