Blank Form Conservatorship

COPYRIGHT ASSIGNMENT

______________________________________ has an office and principal place of business (Assignor)

at ______________________________________________, a _______________________ corporation

(Business Address) (State of Incorporation)

(herein "Assignor"), has created and owns, or through written assignment owns, the entire right, title

and interest in and to the copyright for the work of authorship entitled __________________________

___________________________________________________________________________________

[ ] copy attached

[ ] for which the Assignor has _________________________________________ copyright

(filed an application for/obtained)

registration certificate in the United States Copyright Office, _____________________________,

(Serial/Reg. No.)

filed/granted ___________________.

(filing/grant date)

__________________________________________ has an office and principal

(Assignee)

place of business at _____________________________________________________________,

(Assignee's Address)

a _________________________ corporation (herein "Assignee") and desires to acquire Assignor's

(State of Incorporation)

entire right, title and interest in and to the copyright and the above-identified application/registration.

For good and valuable consideration, the receipt and adequacy of which are acknowledged, the Assignor assigns to the Assignee the Assignor’s entire right, title and interest in and to the copyright, and the above-identified ______________________________________.

(application/registration)

By: _____________________________ Date: ______________________

Assignor’s Signature

_____________________________

Typed Name

_____________________________

Title

STATE OF __________________________________)

) ss

COUNTY OF ________________________________)

Subscribed and sworn to before me, a Notary Public, this ___ day of ______________, 20___.

_____________________________________

(SEAL) Notary Public