Check box if continuation sheets for additional works are attached.

Notice to Libraries and Archives of Normal Commercial Exploitation or Availability at Reasonable Price

1. Title of the work (or, if untitled, a brief description of the work): __________.

2. Author(s) of the work: __________.

3. Type of work (e.g. music, motion picture, book, photograph, illustration, map, article in a periodical, painting, sculpture, sound recording, etc.): __________.

4. Edition, if any (e.g., first edition, second edition, teacher's edition) or version, if any (e.g., orchestral arrangement, English translation of French text). If there is no information available relating to the edition or version of the work, the Notice should state, “No information available”: __________.

5. Year of first publication: _____.

6. Year the work first secured federal copyright through publication with notice or registration as an unpublished work: _____.

7. Copyright renewal registration number (not required for foreign works restored under 17 U.S.C. 104A): _____.

8. Full legal name of the copyright owner (or the owner of exclusive rights): _____.

9. The person or entity identified in space #8 owns:
all rights.
the following rights (e.g., the right to reproduce/distribute/publicly display/publicly perform the work or to prepare a derivative work): _____.

10. Person or entity that the Copyright Office should contact concerning the Notice:
Name:____________________
Address:____________________
Telephone:____________________
Fax number (if any):____________________
E-mail address (if any):____________________

11. Person or entity that libraries and archives may contact concerning the work's normal commercial exploitation or availability at a reasonable price:
Name:____________________
Address:____________________
Telephone:____________________
Fax number (if any):____________________
E-mail address (if any):____________________

Additional Content (OPTIONAL):

12. Original copyright registration number: __________

13. Additional information concerning the work's normal commercial exploitation or availability at a reasonable price: __________

Declaration:

I declare under penalty of perjury under the laws of the United States:

that each work identified in this notice is subject to normal commercial exploitation.

that a copy or phonorecord of each work identified in this notice is available at a reasonable price.

Signature:____________________
Date:____________________
Typed or printed name:____________________
Title:____________________

Appendix B to §201.39—Required Format for Continuation Sheet

NLA CON

Page __of __Pages.

Continuation Sheet for NLA Notice to Libraries and Archives of Normal Commercial Exploitation or Availability at Reasonable Price

1. Title of the work (or, if untitled, a brief description of the work): __________.

2. Type of work (e.g. music, motion picture, book, photograph, illustration, map, article in a periodical, painting, sculpture, sound recording, etc.): __________.

3. Edition, if any (e.g., first edition, second edition, teacher's edition) or version, if any (e.g., orchestral arrangement, English translation of French text). If there is no information available relating to the edition or version of the work, the Notice should state, “No information available”: __________.

4. Copyright renewal registration number (not required for foreign works restored under 17 U.S.C. 104A): __________.

Additional Content (OPTIONAL):

5. Original copyright registration number: __________.

6. Additional information concerning the work's normal commercial exploitation or availability at a reasonable price: __________.

[63 FR 71787, Dec. 30, 1998, as amended at 66 FR 34373, June 28, 2001]