Content Removal Request - Template, Sample Form Online Pro · US-law
✓ Valid in United States · drafted to comply with local law
Create your Content Removal Request - Template, Sample Form Online for use in United States. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share. This version has been professionally rewritten to comply with local law.
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VIA EMAIL AND CERTIFIED MAIL
DIGITAL MILLENNIUM COPYRIGHT ACT (DMCA) TAKEDOWN NOTICE
Pursuant to 17 U.S.C. § 512(c)(3)
Date: ________
To the Designated Copyright Agent / Service Provider:
Name of Service Provider / Website Operator: ________
Designated Agent: ________
Address: ________
Email: ________
To Whom It May Concern:
This letter constitutes formal notice under the Digital Millennium Copyright Act, 17 U.S.C. § 512, that material posted on your website infringes one or more copyrighted works owned by, or for which I am authorized to act on behalf of, the undersigned. I respectfully request that you expeditiously remove or disable access to the infringing material identified below.
§ 1. Identification of the Complaining Party.
Full Legal Name: ________
Capacity (copyright owner or authorized agent): ________
Address:
________
Telephone Number: ________
Email: ________
§ 2. Identification of the Copyrighted Work(s). I am the owner of, or am authorized to act on behalf of the owner of, the exclusive rights in the following copyrighted work(s) that have been infringed (including, where applicable, the U.S. Copyright Office registration number):
Description of original work(s): ________
Copyright registration number(s), if any: ________
Location of the authorized original work (URL or other reference), if applicable: ________
§ 3. Identification of the Infringing Material. The material that is claimed to be infringing, and that is to be removed or to which access is to be disabled, is located at the following Uniform Resource Locator(s) (URL):
URL of infringing content: ________
Description of the infringing material: ________
§ 5. Statement of Good Faith Belief. I have a good faith belief that the use of the material in the manner complained of is not authorized by the copyright owner, its agent, or the law, as required by 17 U.S.C. § 512(c)(3)(A)(v).
§ 6. Statement of Accuracy and Authority (Under Penalty of Perjury). I declare, under penalty of perjury under the laws of the United States, that the information contained in this notice is accurate and that I am the copyright owner, or am authorized to act on behalf of the owner, of an exclusive right that is allegedly infringed, in accordance with 17 U.S.C. § 512(c)(3)(A)(vi).
§ 8. Enclosures. A copy of the material for which removal is requested, together with supporting documentation evidencing my ownership of the copyrighted work(s), is enclosed with or attached to this notice.
Should you require any additional information in order to process this request, please do not hesitate to contact me using the information provided above. I look forward to your prompt response confirming that the content has been removed.
Sincerely,
______________________________
Signature: ________
Printed Name: ________
Date: ________
Fields you complete are inserted into the document live. This template is general guidance only — not legal advice.