Copyright Questionnaire
 
 
Title of Work:
 
 
Previous Title
 
 
Nature of Material:
 
 
Authors:
(Complete for each author of the work, add additional sheets if necessary)
 
 
Name of Author:
 
 
Work made for hire:
Yes No
 
 
Author's Nationality:
USA
 
 
Date of Birth:
 
 
Anonymous:
Yes No
 
 
Pseudonymous:
Yes No
 
 
Nature of Authorship:
 
 
 
 
Name of Author:
 
 
Work made for hire:
Yes No
 
 
Author's Nationality:
USA
 
 
Date of Birth:
 
 
Anonymous:
Yes No
 
 
Pseudonymous:
Yes No
 
 
Nature of Authorship:
 
 
 
 
Name of Author:
 
 
Work made for hire:
Yes No
 
 
Author's Nationality:
USA
 
 
Date of Birth:
 
 
Anonymous:
Yes No
 
 
Pseudonymous:
Yes No
 
 
Nature of Authorship:
 
 
 
 
Year work completed:
 
 
Date of First Publication:
 
 
Nation of First Pub.:
USA
 
 
Copyright Claimant:
 
 
If assigned to Copyright Claimant, provide copy of assignment
 
 
Previous Registration

YES No

If Yes:

First pub. of previously unregistered work

First application by this claimant

Changed version of prior work

 
 
If Derivative Work identify pre-existing materials
 
 
If Derivative Work identify material added to this Work
 
 
Gordon Troy is authorized agent to file Copyright application
YES
 
 
 
 
For visual works, please complete the following
 
 
Nature of Authorship:
  • 3-Dimensional Sculpture
  • 2-Dimensional ArtWork
  • Reproduction of work of art
  • Design on sheetlike material
  • Map
  • Photograph
  • Jewelry design
  • Technical drawing
  • Text
  • Architectural work
 
 
 
 
For sound recordings, please complete the following
 
 
Selection Title
Words
Music Performance Sound Recording Original Work