Notification of Claimed Infringement
Date: ___________________
U.S.A.
Dear Mr. Cooney:
I, the undersigned, certify
under penalty of perjury, that I am the owner or an agent authorized
to act on behalf of the owner of certain U.S. copyright rights, the owner being
named ______________________________________ (the “ Copyright Owner”). I have a good faith belief that the
materials identified in the Addendum attached to this Notification of Claimed
Infringement are not authorized by the Copyright Owner, its agent, or the law
and therefore infringe the Copyright Owner’s rights according to U.S. law. Kindly act expeditiously to remove or
disable access to the materials claimed to be infringing as identified in the
attached Addendum.
You may contact me
at:
Printed Name: ______________________________________
Title: ______________________________________
Company Name: ______________________________________
Street Address: ______________________________________
City, State, Zip: ______________________________________
E-Mail: ______________________________________
Telephone: ______________________________________
Fax: ______________________________________
I further certify that the information contained in this Notification of Infringement and the Addendum is accurate.
Truthfully,
______________________________________
Signature
______________________________________
Printed Name
Addendum to Notification of Claimed Infringement
List of Allegedly Infringing Materials
Name of Copyright Owner: ______________________________________
Date of Notification
of Claimed
Infringement: ______________________________________
Name of
work: ______________________________________
Format of work: ______________________________________
Location of work: ______________________________________
Size of work: ______________________________________
IP address: ______________________________________
Date/time: ______________________________________
Name of
work: ______________________________________
Format of work: ______________________________________
Location of work: ______________________________________
Size of work: ______________________________________
IP address: ______________________________________
Date/time: ______________________________________
Name of
work: ______________________________________
Format of work: ______________________________________
Location of work: ______________________________________
Size of work: ______________________________________
IP address: ______________________________________
Date/time: ______________________________________
Name of
work: ______________________________________
Format of work: ______________________________________
Location of work: ______________________________________
Size of work: ______________________________________
IP address: ______________________________________
Date/time: ______________________________________
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