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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: ________.

§ 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.

Sincerely,



Signature: ________

Printed Name: ________

Date: ________

Fields you complete are inserted into the document live. This template is general guidance only - not legal advice.