Notice of Intention to Obtain Compulsory License for Making and Distributing Sound Recordings To ___________________________________, the copyright owner of _____________________, written by ______________________________: Pursuant to the compulsory license provisions of the U.S. Copyright Act (17 U.S.C. 1115), we apply for a license to make and distribute phonorecords of _____________________ and provide the following information: Legal name of entity seeking the compulsory license: ________________________ Fictitious or assumed names used for making and distributing phonorecords: __________________________________________________________________ Address: ___________________________________________________________ Business form (check one): [ ] sole proprietor [ ] partnership [ ] limited liability company (LLC) [ ] corporation Names of individuals who own a beneficial interest of 25% or more in the entity: _______________________________________________________________ If a corporation, names of the officers and directors: ________________________________________________________________ Configuration(s) to be made under the compulsory license (check all that apply): [ ] 7- or 12-inch vinyl single [ ] 12-inch long playing vinyl record [ ] cassette [ ] compact disc [ ] minidisc [ ] digital cassette recording Catalog number(s): _______________________________________________________ Label name(s): ___________________________________________________________ Principal recording artists: __________________________________________________ Anticipated date of initial release: _____________________________________________ We agree to pay the copyright owner royalties at the statutory rate provided by the Copyright Act. By: ___________________________________________
Name and Title: ___________________________________________ Date: ______________