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SAMPLE FORM

Lana Poor ¹ has an office and principal place of business at

Assignor

111 Q St., Parden, ME 04102 ² a Maine ³ 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 Make Money! Money! Money!⁴

[ ] copy attached

[ x] for which the Assignor has obtained ⁵ copyright
filed an application for/obtained

registration certificate in the United States Copyright Office, 66 ⁶,
Serial/Reg. No.

filed/granted 9-3-95 ⁷. filing/grant date

Kirk Done ⁸ has an office and principal
Assignee

place of business at 2121 15th St., Des Moines, IA 50316 ⁹,
Assignee's Address

a(n) Iowa ¹⁰ corporation (herein "Assignee") and desires to acquire Assignor's entire
State of Incorporation

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 registration ¹¹.
application/registration

By: Lana Poor ¹² Date: 11-06-2005 ¹⁵
Assignor's Signature

Lana Poor ¹³ Typed Name

Author ¹⁴ Title

STATE OF Maine ¹⁶)

) ss

COUNTY OF Linn ¹⁷)

Subscribed and sworn to before me, a Notary Public, this 6th day of November , 2005¹⁸.

Mary Beth Hopkins ¹⁹ Notary Public

(SEAL)

This is not a substitute for legal advice. An attorney must be consulted.
Copyright ©1994 - 2024 by LAWCHEK, LTD.

The above is an example of how a typical Copyright Assignment form may be completed.

1. The full name of the assignor.

2. The business address of the assignor.

3. The state in which the business is located.

4. The title to be copyrighted.

5. Indicate whether assignor has filed an application for or obtained a copyright registration certificate.

6. This number is assigned by the Patent Office.

7. The date on which the copyright was granted.

8. The full name of the assignee.

9. The full address of the business of the assignee.

10. The state in which the business is located.

11. Indicate whether registration of the copyright has been applied for or whether

the registration of the copyright has already been obtained.

12. The signature of the assignor.

13. The printed name of the assignor.

14. The title of the assignor.

15. The date on which the document is signed.

16. The state in which the copyright is assigned.

17. The county in which the copyright is assigned.

18. The date on which the notary signs the document.

19. The signature of the Notary Public.

This is not a substitute for legal advice. An attorney must be consulted.