Image Removal Request - Template, Sample Form Online

DIGITAL MILLENNIUM COPYRIGHT ACT (DMCA) NOTICE OF CLAIMED INFRINGEMENT AND TAKEDOWN DEMAND

Pursuant to 17 U.S.C. § 512(c)(3)

Date: ________

TO (Designated DMCA Agent / Service Provider):

Name of Recipient / Designated Agent: ________
Service Provider / Website Operator: ________
Address: ________
Email: ________

To Whom It May Concern:

This letter constitutes formal written notification pursuant to Section 512(c) of the Digital Millennium Copyright Act, 17 U.S.C. § 512, that copyrighted material in which I hold exclusive rights is being infringed upon and is accessible through your website or online service. I respectfully demand the immediate removal of, or disabling of access to, the infringing material identified below.

§ 1. Identification of the Complaining Party.

Full Legal Name: ________
Capacity (copyright owner or authorized agent): ________
Mailing Address: ________
Telephone Number: ________
Email Address: ________

§ 2. Identification of the Copyrighted Work Claimed to Have Been Infringed. The copyrighted work that is the subject of this notice is described as follows: ________. The original work was first created and/or published on or about ________. To the extent applicable, the United States Copyright Office registration number for the work is ________. The original work may be located or verified at: ________.

§ 3. Identification and Location of the Infringing Material. The material that is claimed to be infringing, and which I request be removed or to which access be disabled, is located at the following Uniform Resource Locator(s) (URLs) and/or location(s) on your service: ________. Additional infringing location(s), if any: ________.

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§ 5. Good Faith Statement. I have a good faith belief that the use of the copyrighted material described herein, in the manner complained of, is not authorized by the copyright owner, its agent, or the law (including a valid defense such as fair use under 17 U.S.C. § 107).

§ 6. Statement of Accuracy and Authority. I represent that the information in this notification is accurate, and I state UNDER PENALTY OF PERJURY that I am the owner, or am authorized to act on behalf of the owner, of an exclusive right that is allegedly infringed.

§ 7. Consent to Jurisdiction. For purposes of any dispute arising out of this notice, I consent to the jurisdiction of the federal and state courts located in ________, and this notice shall be governed by and construed in accordance with the laws of the United States and the State of ________.

§ 8. Supporting Material. A copy of the material for which removal is requested, together with supporting documentation evidencing my ownership of the copyrighted work, is attached to this notice.

§ 9. Reservation of Rights. Nothing contained in this notice constitutes a complete statement of the facts or law, nor a waiver of any rights or remedies, all of which are expressly reserved.

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse.

Sincerely,

Signature: ________

Printed Name: ________

Date: ________