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Checklist of Required Information (115)

The following information must be contained in each Notice

of Intention to Obtain a Compulsory License for Making and

Distributing Phonorecords.” There is no official form issued

for this filing. For additional information see Circular 96

(201.18 & 201.19)

A statement that the records of the Copyright Office

have been searched for the name and address of the

copyright owner and the results of the search.

There is to be a Separate Notice for each work for

which a compulsory license is desired.

Each Notice is to be designated as “Notice of Intention to Obtain a Compulsory License for Making and

Distributing Phonorecords”.

Each notice is to contain the following:

1 full legal name of the person or entity intending to obtain the compulsory license, together with all fictitious

or assumed names;

2 the address of the place of business of the person or entity. A post office box is normally not acceptable.

3 the nature of the business organization used by the person intending to obtain the license (e.g., corporation,

partnership, etc);

a if it is a corporation registered with the Securities and

Exchange Commission, this should be stated.

b if it is a corporation not registered with the SEC, it

should list the names and officers and each owner of

25% or more securities.

c in all other cases the owners of 25% or more of the securities should be listed.

4 the fiscal year of the person or entity intending to obtain the compulsory license (if the fiscal year is a calendar year the Notice shall so state);

5 the title of the nondramatic musical work and the

name(s) of the author(s) if known;

6 type of all phonorecord configurations (e.g., single

disk, long playing, cassette, etc.) already made and anticipated to be made;

7 the anticipated date of initial distribution of phonorecords already made or anticipated to be made under the

compulsory license;

8 the name of the principal recording artist or group actually engaged or anticipated to be engaged in rendering

the performances fixed on phonorecord;

9 catalog number(s) and label name(s)

10 signature of the person or entity intending to obtain the

compulsory license followed by the printed or typewritten name of the person signing and the date of signature.

Checklists

(Section 115 of Title 17, U.S. Code)
The full legal name of the compulsory licensee, together

with all fictitious or assumed names used by such person

or entity for the purpose of conducting the business of making and distributing phonorecords.

A statement of the nature of the business organization used

by the compulsory licensee in connection with the making

and distribution of phonorecords (for example, a corporation, a partnership, or an individual proprietorship).

1 If the compulsory licensee is a corporation registered with the

Securities and Exchange Commission, the Annual Statement

shall state that this is the case.

2 If the compulsory licensee is a corporation not registered with

the Securities and Exchange Commission, the Annual Statement shall state that this is the case.

3 In all other cases, the Annual Statement shall include the names

of each entity or individual owning a benefice interest of 25%

or more in the entity exercising the compulsory license.

4 Business address ofðcompulsory licensee. (A post office box

or similar designation is not necessarily acceptable, except

where it is the only address that can be used in that geographic

location.)

5 Title of the musical work embodied in phonorecords made under the compulsory license and owned by the copyright owner

being served the Annual Statement.

6 Name of the author of the musical work, if known.

7 The playing time of the musical work.

8 The total royalty payable for the fiscal year.

9 The total sum paid under Monthly Statements of Account.

10 Royalty payment calculation.

11 Signature.

12 Certification. Each Annual Statement of Account shall be certified by a licensed Certified Public Accountant.

Filing and Service*

In general, the filing fees are as follows:

• $12.00 Notice of Intention

• $ 8.00 Certificate of Filing

• No fee for Acknowledgment of Receipt and Filing

*See Circular 96 (37 CFR) Section 201.18(e) and (37 CFR)

Section 201.19(e)(7)(f)(7) for more information.

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Checklist for Monthly Statement of Account

Monthly Statements of Account shall be clearly and prominently

identified as a “Monthly Statement of Account Under Compulsory

License for Making and Distributing Phonorecords,” and must include the following information:

1 Period covered by this statement (month and year).

2 The full legal name of the compulsory licensee, together with

all fictitious or assumed names used by such person or entity

for the purpose of conducting the business of making and distributing phonorecords.

3 Business address of compulsory licensee (A post office box

or similar designation is not necessarily acceptable, except

where it is the only address that can be used in that geographic

location.

4 Title of musical work embodied in phonorecords made under

the compulsory license and owned by the copyright owner

being served with the Monthly Statement.

5 Name of the author of each musical work, if known.

6 Number of phonorecords made during the period covered by

this statement.

7 Catalog number(s) and label name(s) used on the phonorecords.

8 The names of the principal recording artist or group engaged

in rendering the performance fixed on the phonorecords.

 9 The playing time on the phonorecords of each non-dramatic

musical work covered by the statement.

10 Type of configuration (i.e., phonorecord, cassette, single disk,

long playing disk, reel-to-reel).

11 Royalty payment calculation.

12 Oath and signature.

Checklist for Annual Statement of Account

Annual Statements of Account shall be clearly and prominently

identified as an “Annual Statement of Account Under Compulsory

License for Making and Distributing Phonorecords,” and must include a clear statement of the following information:

Period covered by this statement (any Annual Statement of

Account shall cover the full fiscal year of the compulsory

license).

Library of Congress • Copyright Office • Licensing Division • 101 Independence Ave., S.E. • Washington, D.C. 20557-6400

www.copyright.gov

M-200 May 2002—2,000 E Printed on recycled paper U.S. Government Printing Office: 2002–491–424/40,016

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